Urinary Microbiome Characteristics in Female Patients with Acute Uncomplicated Cystitis and Recurrent Cystitis

Abstract

Traditionally, the diagnostic mainstay of recurrent urinary tract infection has been urinary culture. However, the causative uropathogen of recurrent cystitis has not been well established. Urine DNA next-generation sequencing (NGS) can provide additional information on these infections. Herein, we compared urine NGS results and urine cultures in patients with acute uncomplicated cystitis (AUC) and recurrent cystitis (RC), and evaluated the difference in microbiome patterns in the NGS results. Patients who underwent urine culture and NGS due to AUC or RC were retrospectively reviewed. All urine samples were collected via a transurethral catheter and studied utilizing a type of NGS called 16S ribosomal RNA gene amplification and sequencing. The sensitivity of urine NGS was significantly higher than that of conventional urine culture (69.0% vs. 16.7%, p < 0.05). The detection rate of urine NGS was slightly lower in the RC group than in the AUC group (67.7% vs. 72.7%). Microbiome diversity was significantly higher in the RC group compared to the AUC group (p = 0.007), and the microbiome composition was significantly different between the AUC and RC groups. In the urine NGS results, Pseudomonas, Acinetobacter, and Enterobacteriaceae were found in the AUC group, and Sphingomonas, Staphylococcus, Streptococcus, and Rothia spp. were detected in the RC group. Urine NGS can significantly increase the diagnostic sensitivity compared to traditional urine culture methods, especially in RC patients. AUC and RC patients had significant differences in bacterial diversity and patterns. Therefore, recurrent cystitis might be approached from a different perspective.

The Microbiome’s Function in Disorders of the Urinary Bladder

“…Pseudomonas, Acinetobacter, and Enterobacteriaceae were identified in the urine NGS findings for the AUC group, while Sphingomonas, Staphylococcus, Streptococcus, and Rothia spp. were detected in the RC group [46]. Significant variations in bacterial diversity and patterning were seen between AUC and RC patients.…”

“…Significant variations in bacterial diversity and patterning were seen between AUC and RC patients. This study suggests that AUC can be considered a transient infection produced by a single pathogenic organism, while dysbiosis seems to play a more significant role in the pathophysiology of RC [46,47]. RC may be linked with urinary tract dysbiosis, but more study is necessary [46,48].…”

“…This study suggests that UTI symptoms linked with E. coli detection are more likely the result of microbiome composition. Recently, the study comparing urine next-generation sequencing (NGS) of patients with acute uncomplicated cystitis (AUC) and recurrent cystitis (RC) revealed differences in microbiome patterns [46]. Transurethrally obtained urine specimens from the RC group had substantially more microbiome diversity than the AUC group.…”

β-Defensin 2, an Antimicrobial Peptide, as a Novel Biomarker for Ulcerative Interstitial Cystitis; Can β-Defensin 2 Suspect the Dysbiosis of Urine Microbiota?

“…CD is associated with damage to the glycosaminoglycan (GAG) layer, which appears to exhibit histopathological characteristics similar to those of IC. This suggests a new possibility that the immune inflammatory reaction is caused by dysbiosis of the microbiota in the bladder rather than simply causing IC/BPS due to infection by specific bacteria [7,22,23].…”

Gardnerella Vaginalis in Recurrent Urinary Tract Infection is Associated with Dysbiosis of the Bladder Microbiome

“…12 Through a previous pilot study, we demonstrated the difference in bacterial diversity and patterns between RC and acute uncomplicated cystitis. 13 Due to these new techniques, a new disease pathway through gut-vagina-bladder crosstalk has gained focus apart from the traditional mechanism of UTI, which was mainly caused by gut-bladder crosstalk. 7,8,14,15 Such changes in study perspectives can provide good therapeutic clues, particularly in RC, which is di cult to treat with frequent recurrence.…”