Top

International Urogynecology Journal

Published in:

Open Access 01-12-2018 | Original Article

The urinary microbiome in patients with refractory urge incontinence and recurrent urinary tract infection

Authors: Zhuoran Chen, Minh-Duy Phan, Lucy J. Bates, Kate M. Peters, Chinmoy Mukerjee, Kate H. Moore, Mark A. Schembri

Published in: International Urogynecology Journal | Issue 12/2018

Abstract

Introduction and hypothesis

Urinary urge incontinence is a chronic, debilitating condition that is difficult to treat. Patients refractory to standard antimuscarinic therapy often experience recurrent urinary tract infections (rUTIs). The microbiota of these refractory patients with rUTI remains unexplored.

Methods

A midstream urine (MSU) sample was collected from patients with refractory urge incontinence and coexistent rUTI during acute symptomatic episodes. Culture-based diagnosis was performed using routine microbiological methods. Culture-independent profiling was performed using bacterial 16S RNA profiling. E. coli strain typing was performed by amplicon pyrosequencing of the fimH gene.

Results

Over 2 years, 39 patients with refractory urge incontinence and coexistent rUTI were studied, yielding 9 severely affected cases. These 9 patients were carefully monitored for a further 2 years, resulting in the collection of 102 MSU samples, 70 of which were diagnosed as UTI (median of 8 UTIs/woman). Culture-independent analysis of 38 of these samples revealed the existence of a diverse urinary microbiota. Strain typing of E. coli identified instances of rUTI caused by the same persisting strain and by new infecting strains.

Conclusions

Patients with refractory urge incontinence and coexistent rUTI possess a diverse urinary microbiota, suggesting that persistent bladder colonisation might augment the pathology of their chronic condition.

Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. https://doi.org/10.1038/nrdp.2017.42.CrossRefPubMedPubMedCentral

Brubaker L, Wolfe AJ. Microbiota in 2016: associating infection and incontinence with the female urinary microbiota. Nat Rev Urol. 2017;14(2):72–4. https://doi.org/10.1038/nrurol.2016.262.CrossRefPubMedPubMedCentral

Karstens L, Asquith M, Davin S, Stauffer P, Fair D, Gregory WT, et al. Does the urinary microbiome play a role in urgency urinary incontinence and its severity? Front Cell Infect Microbiol. 2016;6:78. https://doi.org/10.3389/fcimb.2016.00078.CrossRefPubMedPubMedCentral

Pearce MM, Hilt EE, Rosenfeld AB, Zilliox MJ, Thomas-White K, Fok C, et al. The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. MBio. 2014;5(4):e01283-01214. https://doi.org/10.1128/mBio.01283-14.CrossRef

Thomas-White KJ, Kliethermes S, Rickey L, Lukacz ES, Richter HE, Moalli P, et al. Evaluation of the urinary microbiota of women with uncomplicated stress urinary incontinence. Am J Obstet Gynecol. 2017;216(1):55.e51–16. https://doi.org/10.1016/j.ajog.2016.07.049.CrossRef

Walsh CA, Siddins A, Parkin K, Mukerjee C, Moore KH. Prevalence of "low-count" bacteriuria in female urinary incontinence versus continent female controls: a cross-sectional study. Int Urogynecol J. 2011;22(10):1267–72. https://doi.org/10.1007/s00192-011-1506-0.CrossRefPubMed

Moore KH, Malykhina AP. What is the role of covert infection in detrusor overactivity, and other LUTD? ICI-RS 2013. Neurourol Urodyn. 2014;33(5):606–10. https://doi.org/10.1002/nau.22589.CrossRefPubMed

Cheng Y, Chen Z, Gawthorne JA, Mukerjee C, Varettas K, Mansfield KJ, Schembri MA, Moore KH (2016) Detection of intracellular bacteria in exfoliated urothelial cells from women with urge incontinence. Pathog Dis 74(7):ftw067. https://doi.org/10.1093/femspd/ftw067.CrossRefPubMed

Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011;5(5):316–22. https://doi.org/10.5489/cuaj.11214.CrossRefPubMedPubMedCentral

10.

Bell SM, Pham JN, Rafferty DL, Allerton JK. Antibiotic susceptibility testing by the CDS method: a manual for medical and veterinary laboratories. 8th ed. Sydney: The CDS Reference Laboratory; 2016.

11.

Schloss PD, Westcott SL, Ryabin T, Hall JR, Hartmann M, Hollister EB, et al. Introducing mothur: open-source, platform-independent, community-supported software for describing and comparing microbial communities. Appl Environ Microbiol. 2009;75(23):7537–41. https://doi.org/10.1128/AEM.01541-09.CrossRefPubMedPubMedCentral

12.

Edgar RC, Haas BJ, Clemente JC, Quince C, Knight R. UCHIME improves sensitivity and speed of chimera detection. Bioinformatics. 2011;27(16):2194–200. https://doi.org/10.1093/bioinformatics/btr381.CrossRefPubMedPubMedCentral

13.

Gu Z, Eils R, Schlesner M. Complex heatmaps reveal patterns and correlations in multidimensional genomic data. Bioinformatics. 2016;32(18):2847–9. https://doi.org/10.1093/bioinformatics/btw313.CrossRefPubMed

14.

Willner D, Low S, Steen JA, George N, Nimmo GR, Schembri MA, et al. Single clinical isolates from acute uncomplicated urinary tract infections are representative of dominant in situ populations. MBio. 2014;5(2):e01064–13. https://doi.org/10.1128/mBio.01064-13.CrossRefPubMedPubMedCentral

15.

Hannan TJ, Totsika M, Mansfield KJ, Moore KH, Schembri MA, Hultgren SJ. Host-pathogen checkpoints and population bottlenecks in persistent and intracellular uropathogenic Escherichia coli bladder infection. FEMS Microbiol Rev. 2012;36(3):616–48. https://doi.org/10.1111/j.1574-6976.2012.00339.x.CrossRefPubMed

16.

Rosen DA, Hooton TM, Stamm WE, Humphrey PA, Hultgren SJ. Detection of intracellular bacterial communities in human urinary tract infection. PLoS Med. 2007;4(12):e329. https://doi.org/10.1371/journal.pmed.0040329.CrossRefPubMedPubMedCentral

17.

Thomas-White KJ, Hilt EE, Fok C, Pearce MM, Mueller ER, Kliethermes S, et al. Incontinence medication response relates to the female urinary microbiota. Int Urogynecol J. 2016;27(5):723–33. https://doi.org/10.1007/s00192-015-2847-x.CrossRefPubMed

Title: The urinary microbiome in patients with refractory urge incontinence and recurrent urinary tract infection
Authors: Zhuoran Chen
Minh-Duy Phan
Lucy J. Bates
Kate M. Peters
Chinmoy Mukerjee
Kate H. Moore
Mark A. Schembri
Publication date: 01-12-2018
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 12/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3679-2

At a glance: The STEP trials

Springer Medicine

The urinary microbiome in patients with refractory urge incontinence and recurrent urinary tract infection

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2018

Commentary on: Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients

Urogenital symptoms: prevalence, bother, associations and impact in 22 year-old women of the Raine Study

Professor Oscar Contreras Ortiz (1935–2017): remembering one of urogynecology’s true visionaries

“Occult” pelvic abscess following previous robotic sacrocolpopexy

A systematic review of outcome and outcome-measure reporting in randomised trials evaluating surgical interventions for anterior-compartment vaginal prolapse: a call to action to develop a core outcome set

Test–retest reliability of internal pudendal artery blood flow using color Doppler ultrasound in healthy women