Multiple urinary cytokine levels of bacterial cystitis

We have examined urinary cytokine levels to define the inflammatory response in patients with bacterial cystitis or microhematuria relative to normal subjects. Cytokines examined include interleukin-1beta (IL-1beta), IL-1alpha, tumor necrosis factor (TNF alpha), IL-6 and IL-4. Unique features of this study include a) a simultaneous study of several relevant cytokines b) a study of the inflammatory response at both low and high counts of bacterial infection and c) an assessment of whether microhematuria without bacterial cystitis or pyuria is associated with cytokine elevation compared to normals.

Enzyme immunoassays were utilized for each cytokine. Patients studied include those with bacterial cystitis (n = 49), patients with microhematuria (n = 11), and normal subjects (n = 36). Cytokine levels were also determined for patients with low count bacterial cystitis (1,000-50,000 organisms; n = 15) and compared to high count bacterial cystitis (>100,000 organisms; n = 34) and normal subjects. Statistical analysis was carried out using the Kruskal-Wallis test followed by pairwise testing with Newman-Keuls test.

a) The means for normal, microhematuria and bacterial cystitis groups were significantly different (p <0.05) for IL-1beta, IL-1alpha, TNF alpha and IL-6, but not for IL-4. b) Except for IL-4, all cytokines were found to be significantly elevated in low count bacterial cystitis compared to normals. No statistically significant difference was observed between low and high count bacterial cystitis groups for any of the cytokines tested.

a) Significant and similar inflammatory responses are present in both low and high count bacterial cystitis groups as compared with the normal group. b) IL-6 and TNF alpha are significantly elevated in patients with microhematuria compared to normals. c) The potential clinical utility of the assays lies in identifying the specific cytokines elevated, understanding the pathways that give rise to their production, and in defining potential virulence factors that may produce significant inflammation at low count bacterial infections.