Skip to main content

15.11.2019 | Overactive Bladder (U Lee and S Adelstein, Section Editors)

The Bladder is Not Sterile: an Update on the Urinary Microbiome

verfasst von: A. Lenore Ackerman, Toby C. Chai

Erschienen in: Current Bladder Dysfunction Reports

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The article discusses (1) techniques used to study bacterial urinary microbiota; (2) existence of non-bacterial urinary microbiota; (3) associations between changes in urinary microbiota and various benign lower urinary tract disorders.

Recent Findings

Urine harbors a diverse microbial community that resides within it. A multitude of studies have identified differences in these communities associated with urologic conditions, suggesting that microbial communities may maintain normal bladder homeostasis. Technological advances in analytic approaches have improved our understanding of the urinary microbiome. The choice of urine sampling method (voided, catheterized, or aspirated) will significantly influence microbiome findings. Sex and age highly influence urinary microbiota; in addition to rigorous inclusion criteria, microbial studies must be sufficiently powered to overcome the substantial interindividual variability of urinary microbiota. Regardless of these complicating factors, studies have identified microbial patterns correlating with both urologic diagnoses and treatment responses.

Summary

Without a clear understanding of the variability of and exogenous influences on the urinary microbiota in the absence of disease, it has been challenging to reveal the microbial patterns responsible for disease pathophysiology. Host mechanisms in response to the urinary microbiome are also poorly understood. Additional research can address whether the manipulation of urinary microbiota will benefit lower urinary tract health.
Literatur
3.
Zurück zum Zitat •• Karstens L, Asquith M, Caruso V, Rosenbaum JT, Fair DA, Braun J, et al. Community profiling of the urinary microbiota: considerations for low-biomass samples. Nat Rev Urol. 2018;15(12):735–49. https://doi.org/10.1038/s41585-018-0104-zThis is an in-depth exploration of the detailed decisions in the analysis of microbial sequence data that can influence the results and findings of microbiome studies of the urinary tract.CrossRefPubMedPubMedCentral •• Karstens L, Asquith M, Caruso V, Rosenbaum JT, Fair DA, Braun J, et al. Community profiling of the urinary microbiota: considerations for low-biomass samples. Nat Rev Urol. 2018;15(12):735–49. https://​doi.​org/​10.​1038/​s41585-018-0104-zThis is an in-depth exploration of the detailed decisions in the analysis of microbial sequence data that can influence the results and findings of microbiome studies of the urinary tract.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat • Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, et al. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012;50(4):1376–83. https://doi.org/10.1128/JCM.05852-11One of the first descriptions of the presence of bacteria within the urinary tract; it is also the only study to detail the profound differences in microbial communities detected with different methods of sampling the urinary tract.CrossRefPubMedPubMedCentral • Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, et al. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012;50(4):1376–83. https://​doi.​org/​10.​1128/​JCM.​05852-11One of the first descriptions of the presence of bacteria within the urinary tract; it is also the only study to detail the profound differences in microbial communities detected with different methods of sampling the urinary tract.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Ackerman AL, Khalique MU, Ackerman JE, Tang J, Kim J, Underhill DM et al. Optimization of DNA extraction from human urinary samples for mycobiome community profiling. PLoS One. 2019;14(4).CrossRef Ackerman AL, Khalique MU, Ackerman JE, Tang J, Kim J, Underhill DM et al. Optimization of DNA extraction from human urinary samples for mycobiome community profiling. PLoS One. 2019;14(4).CrossRef
16.
Zurück zum Zitat •• Thomas-White K, Forster SC, Kumar N, Van Kuiken M, Putonti C, Stares MD, et al. Culturing of female bladder bacteria reveals an interconnected urogenital microbiota. Nat Commun. 2018;9(1):1557. https://doi.org/10.1038/s41467-018-03968-5Cross-sectional sampling of the urogenital tract in a cohort of female patients reveals strong interrelationship between the vaginal and urinary microbiome that may suggest an interconnected urogenital microbiome, at least in women.CrossRefPubMedPubMedCentral •• Thomas-White K, Forster SC, Kumar N, Van Kuiken M, Putonti C, Stares MD, et al. Culturing of female bladder bacteria reveals an interconnected urogenital microbiota. Nat Commun. 2018;9(1):1557. https://​doi.​org/​10.​1038/​s41467-018-03968-5Cross-sectional sampling of the urogenital tract in a cohort of female patients reveals strong interrelationship between the vaginal and urinary microbiome that may suggest an interconnected urogenital microbiome, at least in women.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat • 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-xThe baseline urinary microbiome prior to treatment in a population of women with UUI was related to medication responses, providing the first evidence that the urinary microbiome may be a useful prognostic biomarker in the classification of patients with benign urologic conditions.CrossRefPubMed • 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-xThe baseline urinary microbiome prior to treatment in a population of women with UUI was related to medication responses, providing the first evidence that the urinary microbiome may be a useful prognostic biomarker in the classification of patients with benign urologic conditions.CrossRefPubMed
22.
Zurück zum Zitat • Abernethy MG, Rosenfeld A, White JR, Mueller MG, Lewicky-Gaupp C, Kenton K. Urinary microbiome and cytokine levels in women with interstitial cystitis. Obstet Gynecol. 2017;129(3):500–6. https://doi.org/10.1097/AOG.0000000000001892This small study of a cohort of women with interstitial cystitis and age-matched controls identified alterations in the microbiome that also correlated with both increased inflammatory cytokine levels and worsening symptom scores, suggesting a functional consequence associated with shifts in urogenital microbial communities.CrossRef • Abernethy MG, Rosenfeld A, White JR, Mueller MG, Lewicky-Gaupp C, Kenton K. Urinary microbiome and cytokine levels in women with interstitial cystitis. Obstet Gynecol. 2017;129(3):500–6. https://​doi.​org/​10.​1097/​AOG.​0000000000001892​This small study of a cohort of women with interstitial cystitis and age-matched controls identified alterations in the microbiome that also correlated with both increased inflammatory cytokine levels and worsening symptom scores, suggesting a functional consequence associated with shifts in urogenital microbial communities.CrossRef
31.
Zurück zum Zitat • Hilt EE, McKinley K, Pearce MM, Rosenfeld AB, Zilliox MJ, Mueller ER, et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol. 2014;52(3):871–6. https://doi.org/10.1128/JCM.02876-13This paper describes the use of an enhanced culture technique to show that multiple genera of bacteria are culturable from urine obtained by catheterization from asymptomatic women.CrossRefPubMedPubMedCentral • Hilt EE, McKinley K, Pearce MM, Rosenfeld AB, Zilliox MJ, Mueller ER, et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol. 2014;52(3):871–6. https://​doi.​org/​10.​1128/​JCM.​02876-13This paper describes the use of an enhanced culture technique to show that multiple genera of bacteria are culturable from urine obtained by catheterization from asymptomatic women.CrossRefPubMedPubMedCentral
33.
34.
Zurück zum Zitat • Nickel JC, Stephens A, Landis JR, Mullins C, van Bokhoven A, Lucia MS, et al. Assessment of the lower urinary tract microbiota during symptom flare in women with urologic chronic pelvic pain syndrome: a MAPP network study. J Urol. 2016;195(2):356–62. https://doi.org/10.1016/j.juro.2015.09.075In a large cohort of patients with urologic chronic pelvic pain syndrome, an association of worsening symptoms, dubbed symptomatic “flares”, was associated with increased detection of urinary fungi, revealing an importance for non-bacterial organisms in disease is is being increasingly recognized for other organ systems.CrossRefPubMed • Nickel JC, Stephens A, Landis JR, Mullins C, van Bokhoven A, Lucia MS, et al. Assessment of the lower urinary tract microbiota during symptom flare in women with urologic chronic pelvic pain syndrome: a MAPP network study. J Urol. 2016;195(2):356–62. https://​doi.​org/​10.​1016/​j.​juro.​2015.​09.​075In a large cohort of patients with urologic chronic pelvic pain syndrome, an association of worsening symptoms, dubbed symptomatic “flares”, was associated with increased detection of urinary fungi, revealing an importance for non-bacterial organisms in disease is is being increasingly recognized for other organ systems.CrossRefPubMed
46.
Zurück zum Zitat • Miller-Ensminger T, Garretto A, Brenner J, Thomas-White K, Zambom A, Wolfe AJ et al. Bacteriophages of the urinary microbiome. J Bacteriol. 2018;200(7). doi:https://doi.org/10.1128/JB.00738-17. This study provides early evidence of the existence of abundant and novel bacteriophages within the urinary tract that likely influence both the composition of the urinary microbiome as well as urologic disease. • Miller-Ensminger T, Garretto A, Brenner J, Thomas-White K, Zambom A, Wolfe AJ et al. Bacteriophages of the urinary microbiome. J Bacteriol. 2018;200(7). doi:https://​doi.​org/​10.​1128/​JB.​00738-17. This study provides early evidence of the existence of abundant and novel bacteriophages within the urinary tract that likely influence both the composition of the urinary microbiome as well as urologic disease.
56.
Zurück zum Zitat Nickel JC, Stephens-Shields AJ, Landis JR, Mullins C, van Bokhoven A, Lucia MS et al. A culture-independent analysis of the microbiota of female interstitial cystitis/bladder pain syndrome participants in the MAPP Research Network. J Clin Med. 2019;8(3). doi:https://doi.org/10.3390/jcm8030415.CrossRef Nickel JC, Stephens-Shields AJ, Landis JR, Mullins C, van Bokhoven A, Lucia MS et al. A culture-independent analysis of the microbiota of female interstitial cystitis/bladder pain syndrome participants in the MAPP Research Network. J Clin Med. 2019;8(3). doi:https://​doi.​org/​10.​3390/​jcm8030415.CrossRef
57.
Zurück zum Zitat Meriwether KV, Lei Z, Singh R, Gaskins J, DTG H. Jala V. The vaginal and urinary microbiomes in premenopausal women with interstitial cystitis/bladder pain syndrome as compared to unaffected controls: a pilot cross-sectional study. Front Cell Infect Microbiol. 2019;9:92. https://doi.org/10.3389/fcimb.2019.00092. Meriwether KV, Lei Z, Singh R, Gaskins J, DTG H. Jala V. The vaginal and urinary microbiomes in premenopausal women with interstitial cystitis/bladder pain syndrome as compared to unaffected controls: a pilot cross-sectional study. Front Cell Infect Microbiol. 2019;9:92. https://​doi.​org/​10.​3389/​fcimb.​2019.​00092.
69.
Zurück zum Zitat •• Schreiber HLt, Conover MS, Chou WC, Hibbing ME, Manson AL, Dodson KW et al. Bacterial virulence phenotypes of Escherichia coli and host susceptibility determine risk for urinary tract infections. Sci Transl Med. 2017;9(382). doi:https://doi.org/10.1126/scitranslmed.aaf1283. This comparative genomic study examining a panel of E. coli isolates from women with urinary tract infections revealed conserved functional, but not genomic, virulence patterns at the bacterial strain level, suggesting important host-pathogen interactions at the root of infection susceptibility. CrossRef •• Schreiber HLt, Conover MS, Chou WC, Hibbing ME, Manson AL, Dodson KW et al. Bacterial virulence phenotypes of Escherichia coli and host susceptibility determine risk for urinary tract infections. Sci Transl Med. 2017;9(382). doi:https://​doi.​org/​10.​1126/​scitranslmed.​aaf1283. This comparative genomic study examining a panel of E. coli isolates from women with urinary tract infections revealed conserved functional, but not genomic, virulence patterns at the bacterial strain level, suggesting important host-pathogen interactions at the root of infection susceptibility. CrossRef
74.
Zurück zum Zitat • Gilbert NM, O'Brien VP, Lewis AL. Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease. PLoS Pathog. 2017;13(3):e1006238. https://doi.org/10.1371/journal.ppat.1006238In mice primed for recurrent urinary tract infections, intraurethral innoculation of Gardnerella, a bacterium associated in humans with bacterial vaginosis, can promote the development of E. coli urinary tract infection, suggesting that infection risk is a complex interplay not only between host and pathogen but that the microbial environment can also promote infection.CrossRefPubMedPubMedCentral • Gilbert NM, O'Brien VP, Lewis AL. Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease. PLoS Pathog. 2017;13(3):e1006238. https://​doi.​org/​10.​1371/​journal.​ppat.​1006238In mice primed for recurrent urinary tract infections, intraurethral innoculation of Gardnerella, a bacterium associated in humans with bacterial vaginosis, can promote the development of E. coli urinary tract infection, suggesting that infection risk is a complex interplay not only between host and pathogen but that the microbial environment can also promote infection.CrossRefPubMedPubMedCentral
79.
Zurück zum Zitat • Mulder M, Radjabzadeh D, Hassing RJ, Heeringa J, Uitterlinden AG, Kraaij R, et al. The effect of antimicrobial drug use on the composition of the genitourinary microbiota in an elderly population. BMC Microbiol. 2019;19(1):9. https://doi.org/10.1186/s12866-018-1379-1Despite widespread use of antibiotics to treat uropathogens such as E. coli, this examination of older adults after treatment with antibiotics revealed decreases in the classic anti-inflammatory commensals such as Lactobacillus and increases in E. coli after treatment, which should caution the use of antimicrobials for “Eradication” of uropathogens, particularly in asymptomatic patients.CrossRefPubMedPubMedCentral • Mulder M, Radjabzadeh D, Hassing RJ, Heeringa J, Uitterlinden AG, Kraaij R, et al. The effect of antimicrobial drug use on the composition of the genitourinary microbiota in an elderly population. BMC Microbiol. 2019;19(1):9. https://​doi.​org/​10.​1186/​s12866-018-1379-1Despite widespread use of antibiotics to treat uropathogens such as E. coli, this examination of older adults after treatment with antibiotics revealed decreases in the classic anti-inflammatory commensals such as Lactobacillus and increases in E. coli after treatment, which should caution the use of antimicrobials for “Eradication” of uropathogens, particularly in asymptomatic patients.CrossRefPubMedPubMedCentral
81.
Zurück zum Zitat Modena BD, Milam R, Harrison F, Cheeseman JA, Abecassis MM, Friedewald JJ, et al. Changes in urinary microbiome populations correlate in kidney transplants with interstitial fibrosis and tubular atrophy documented in early surveillance biopsies. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2017;17(3):712–23. https://doi.org/10.1111/ajt.14038.CrossRef Modena BD, Milam R, Harrison F, Cheeseman JA, Abecassis MM, Friedewald JJ, et al. Changes in urinary microbiome populations correlate in kidney transplants with interstitial fibrosis and tubular atrophy documented in early surveillance biopsies. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2017;17(3):712–23. https://​doi.​org/​10.​1111/​ajt.​14038.CrossRef
Metadaten
Titel
The Bladder is Not Sterile: an Update on the Urinary Microbiome
verfasst von
A. Lenore Ackerman
Toby C. Chai
Publikationsdatum
15.11.2019
Verlag
Springer US
Erschienen in
Current Bladder Dysfunction Reports
Print ISSN: 1931-7212
Elektronische ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-019-00543-6

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Fehlerkultur in der Medizin – Offenheit zählt!

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.