Urine trouble: should we think differently about UTI?

Price, Travis K.; Hilt, Evann E.; Dune, Tanaka; Mueller, Elizabeth R.; Wolfe, Alan J.; Brubaker, Linda

doi:10.1007/s00192-017-3528-8

Cited by 65 publications

(55 citation statements)

References 22 publications

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“…These findings relate to an increasing concern about the clinical algorithm for the management of women who do not have symptoms of UTI, yet have a positive urine culture. Prior to the discovery of the urobiome, the term ‘asymptomatic bacteriuria’ was broadly applied to such patients; however, the utility of this term is being reconsidered in order to avoid inappropriate antibiotic use and to optimise antibiotic stewardship . Although Gardnerella urotypes have been reported in the adult female bladder, this is the first report indicating that the Gardnerella urotype is common in young but not older women.…”

Section: Discussionmentioning

confidence: 99%

The urobiome of continent adult women: a cross‐sectional study

Price

Hilt

Thomas‐White

et al. 2019

BJOG

105

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Objective To characterise the bladder microbiota of continent adult women.Design Cross-sectional study of adult women who contributed catheterised urine samples, completed validated symptom questionnaires, and provided demographic data.Setting US academic medical centre.Population Well-characterised continent adult women.Methods Participants contributed symptoms questionnaires, demographic data, and catheterised urine samples that were analysed by enhanced urine culture methodology and 16S rRNA gene sequencing.Main outcome measures Associations between demographics and microbial community state structures (urotypes, defined by the dominant taxon of each specimen). ResultsThe bladder microbiota (urobiome) of a control group of 224 continent women were characterised, demonstrating variability in terms of urotype. The most common urotype was Lactobacillus (19%), which did not differ with any demographic. In contrast, the Gardnerella (P < 0.001) and Escherichia (P = 0.005) urotypes were more common in younger and older women, respectively.Conclusions For urobiome research, enhanced culture methods and/or DNA sequencing are the preferred techniques for bacterial detection. The interpretation of clinical tests, such as the standard urine culture, should incorporate the knowledge that some women have Gardnerella or Escherichia urotypes without evidence of any clinical disorder. Clinical care strategies should preserve or restore the beneficial effects of the native urobiome, as disruption of that microbial community could result in unintended vulnerability to uropathogen invasion or opportunistic pathogen overgrowth. Longitudinal studies of urobiome responses to therapies should be encouraged.Keywords Bladder health, female bladder, urinary microbiome, urinary microbiota, urobiome.Tweetable abstract In continent adult women bladder microbiome composition differs by age, with relevance for clinical practice.

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Section: Discussionmentioning

confidence: 99%

The urobiome of continent adult women: a cross‐sectional study

Price

Hilt

Thomas‐White

et al. 2019

BJOG

105

View full text Add to dashboard Cite

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“…As our knowledge of the bladder microbiome continues to expand, the simple dichotomous definition of “UTI” may need to be reconsidered 23 . We were intrigued to detect potential uropathogens in women who did not develop UTI.…”

Section: Discussionmentioning

confidence: 99%

Urinary microbes and postoperative urinary tract infection risk in urogynecologic surgical patients

et al. 2018

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OBJECTIVES: Women have a 20% risk of developing a urinary tract infection (UTI) following urogynecologic surgery. This study assessed the association of post-operative UTI with bacteria in pre-operative samples of catheterized urine. METHODS: Immediately before surgery, vaginal swabs, perineal swabs and catheterized urine samples were collected and the V4 region of the 16S rRNA gene was sequenced. The cohort was dichotomized in two ways: 1) standard day-of-surgery urine culture result (positive/negative) and 2) occurrence of post-operative UTI (positive/negative). Characteristics of the bladder, vaginal and perineal microbiomes were assessed to identify factors associated with post-operative UTI. RESULTS: 87% of the 104 POP/UI surgical patients were white; the mean age was 57 years. The most common genus was Lactobacillus with a mean relative abundance of 39.91% in catheterized urine, 53.88% in vaginal swabs, and 30.28% in perineal swabs. Two distinct clusters, based on dispersion of catheterized urine (i.e., bladder) microbiomes, had highly significant (p<2.2e-16) differences in age, microbes and post-operative UTI risk. Post-operative UTI was most associated with the bladder microbiome; microbes in adjacent pelvic floor niches also contributed to UTI risk. UTI risk was associated with depletion of Lactobacillus iners and enrichment of a diverse mixture of uropathogens. CONCLUSIONS: Post-operative UTI risk appears associated with pre-operative bladder microbiome composition, where an abundance of L. iners appears to protect against post-operative UTI.

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“…Few studies have analyzed the urinary microbial composition by laboratory outcome (i.e., negative, mixed, positive cultures), and the majority of such work has assessed culture techniques adopted in U.S. laboratories (6, 27–30). Given the limitations of culture-based microbial detection (31–33), characterization of microbial communities in health and disease is now becoming increasingly dependent on approaches, such as DNA-based identification, which do not require growth under particular culture conditions (34).…”

Section: Introductionmentioning

confidence: 99%

Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection

et al. 2019

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Midstream urine (MSU) culture remains the gold standard diagnostic test for confirming urinary tract infection (UTI). We previously showed that patients with chronic lower urinary tract symptoms (LUTS) below the diagnostic cutoff on MSU culture may still harbor bacterial infection and that their antibiotic treatment was associated with symptom resolution. Here, we evaluated the results of the United Kingdom’s MSU culture in symptomatic patients and controls. Next, we compared the bacterial enrichment capabilities of the MSU culture with those of a 50-µl uncentrifuged culture, a 30-ml centrifuged sediment culture, and 16S rRNA gene sequencing. This study was conducted on urine specimens from 33 LUTS patients attending their first clinical appointment (mean age, 48.7 years; standard deviation [SD], 16.5 years), 30 LUTS patients on treatment (mean age, 47.8 years; SD, 16.5 years) whose symptoms had relapsed, and 29 asymptomatic controls (mean age, 40.7 years, SD, 15.7 years). We showed that the routine MSU culture, adopting the UK interpretation criteria tailored to acute UTI, failed to detect a variety of bacterial species, including recognized uropathogens. Moreover, the diagnostic MSU culture was unable to discriminate between patients and controls. In contrast, genomic analysis of urine enriched by centrifugation discriminated between the groups, generating a more accurate understanding of species richness. In conclusion, the United Kingdom’s MSU protocol misses a significant proportion of bacteria, which include recognized uropathogens, and may be unsuitable for excluding UTI in patients with LUTS.

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Urine trouble: should we think differently about UTI?

Cited by 65 publications

References 22 publications

The urobiome of continent adult women: a cross‐sectional study

The urobiome of continent adult women: a cross‐sectional study

Urinary microbes and postoperative urinary tract infection risk in urogynecologic surgical patients

Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection

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