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

Abstract

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.

Genomic Survey of E. coli From the Bladders of Women With and Without Lower Urinary Tract Symptoms

“…Members of the Loyola Urinary Education and Research Collaborative (LUEREC), specifically clinicians from the Female Pelvic Medicine and Reconstructive Surgery Center at Loyola University Medical Campus (LUMC), performed recruitment and urine collection. Participants were recruited as a part of separate studies ( Hilt et al, 2014 ; Pearce et al, 2014 , 2015 ; Price et al, 2016 , 2020 ; Thomas-White et al, 2016 , 2018a ; Dune et al, 2017 ).…”

“…This technique bypasses the vulva, vagina, and urethra, thus resulting in samples of bacterial isolates specifically from the bladder niche ( Wolfe et al, 2012 ). All samples underwent standard urine culture (SUC), as well as expanded quantitative urine culture (EQUC), as part of the aforementioned studies ( Hilt et al, 2014 ; Pearce et al, 2014 , 2015 ; Price et al, 2016 , 2020 ; Thomas-White et al, 2016 , 2018a ; Dune et al, 2017 ). For SUC, 1 μL of urine was inoculated onto 5% sheep blood agar plate (BAP) and MacConkey agar plate (BD BBL prepared plated media), and incubated aerobically at 35°C for 24 h. The detection level was 1000 colony forming unit (CFU) per mL, represented by 1 colony of growth on either plate.…”

“…The urobiome of women without lower urinary tract symptoms (LUTS) often includes species of the genera Lactobacillus , Corynebacterium , Gardnerella , Staphylococcus , and Streptococcus (see review; Brubaker and Wolfe, 2017 ). Traditionally, it has been thought that the incidence of E. coli in the urinary tract necessitated infection and symptoms, but the discovery of the urobiome and isolation of E. coli in asymptomatic people indicates otherwise ( Thomas-White et al, 2018b ; Price et al, 2020 ). Moreover, the native microbiota of the bladder has been shown to be distinct from the gastrointestinal tract ( Thomas-White et al, 2018a ; Price et al, 2020 ).…”

“…Traditionally, it has been thought that the incidence of E. coli in the urinary tract necessitated infection and symptoms, but the discovery of the urobiome and isolation of E. coli in asymptomatic people indicates otherwise ( Thomas-White et al, 2018b ; Price et al, 2020 ). Moreover, the native microbiota of the bladder has been shown to be distinct from the gastrointestinal tract ( Thomas-White et al, 2018a ; Price et al, 2020 ). Thus, a UTI may not always be due to a uropathogen invasion; instead, the urinary tract could itself be the source of UPEC strains.…”

Introducing Lu-1, a Novel Lactobacillus jensenii Phage Abundant in the Urogenital Tract

“…A decreased abundance of lactobacilli within the vagina has been associated with decreased conception rates and increased rates of early pregnancy loss [18], as well as bacterial vaginosis (BV) [19]. Lactobacilli are also abundant within the urinary microbiota of women with and without lower urinary tract symptoms (LUTS) [20][21][22][23][24][25][26][27]. While L. gasseri is more frequently detected in the urinary microbiota of women with urgency urinary incontinence, L. crispatus is more frequently found within the urinary microbiota of women without LUTS [20].…”