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

Abstract

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.

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

“…This is consistent with other studies that have shown that Lactobacillus is common in the bladders of adult women with and without lower urinary symptoms . It is not surprising that Lactobacillus predominates the urobiome of many adult women, given the beneficial role that Lactobacillus generally plays in other microbial niches, and the evidence that certain Lactobacillus species are associated with a lack of lower urinary tract symptoms and reduce the risk of post‐surgical UTI , . Injudicious antibiotic use may have collateral effects that reduce the Lactobacillus population, causing an unintended, subsequent vulnerability to the urobiome; a vulnerable urobiome may be more susceptible to invasion and/or overgrowth of opportunistic pathogens that are or may be associated with lower urinary tract symptoms.…”

Oligosaccharides and Complex Carbohydrates: A New Paradigm for Cranberry Bioactivity

“…The function of this urinary protein is not well understood, but it is associated with both cardiovascular and UT health and may influence overall UT host-microbiota interactions [317,318]. Trials investigating catheter-associated UTIs [319,320] already typically consider the unique microbiota profiles associated with these devices, but must now also consider the impact that cranberry materials may have on both initial patient UT microbiomes and on the development of both catheter biofilms and subsequent UTIs [63,321]. Clinical trials that investigate the concurrent use of cranberry materials and probiotics [313] must consider the possible prebiotic effects of cranberry oligosaccharides on both the existing microbiota and the provided probiotic organisms, as well as the possible colonization of the UT with the probiotic organisms [322,323].…”

Species level resolution of female bladder microbiota from 16S rRNA amplicon sequencing

“…The discovery of the bladder microbiota (also known as the bladder urobiome) has led researchers to question how these microbes influence the health of the host. Studies have shown that altered bladder urobiome diversity is associated with urgency urinary incontinence (UUI) (4,8), urinary tract infection after instrumentation of the urinary tract (9,10), and is predictive of response to a common UUI drug (11). These studies collectively provide evidence that the bladder urobiome, while previously overlooked, is clinically relevant and warrants further investigation.…”