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

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d875325e226">OBJECTIVES:</h5> <p id="P13">Persistent and <i>de novo</i> symptoms decrease satisfaction after urogynecologic surgery. We investigated whether the pre-operative bladder microbiome is associated with urinary symptoms prior to and after urogynecological surgery. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d875325e234">METHODS:</h5> <p id="P14">126 participants contributed responses to the validated OABq symptom questionnaire. Catheterized (bladder) urine samples and vaginal and perineal swabs were collected immediately pre-operatively. Bacterial DNA in the urine samples and swabs was sequenced and classified. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d875325e239">RESULTS:</h5> <p id="P15">Pre-operative symptom severity was significantly worse in sequence-positive patients. Higher OABq Symptom Severity (OABqSS) scores (more symptomatic) were associated with higher abundance in bladder urine of two bacterial species: <i>Atopobium vaginae</i> and <i>Finegoldia magna</i>. The presence of <i>Atopobium vaginae</i> in bladder urine also was correlated with its presence in either the vagina or perineum. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d875325e253">CONCLUSIONS:</h5> <p id="P16">Two specific bacterial species detected in bladder urine, <i>Atopobium vaginae</i> and <i>Finegoldia magna</i>, are associated with pre-operative urinary symptoms severity in women undergoing POP/SUI surgery. The reservoir for <i>Atopobium vaginae</i> may be an adjacent pelvic floor niches. This observations should be validated in a larger cohort to determine whether there is a microbiological etiology for certain pre-operative urinary symptoms. </p> </div><p id="P64">In women undergoing POP/SUI surgery, two bacterial species detected in bladder urine, <i>Atopobium vaginae</i> and <i>Fingoldia magna</i>, are associated with pre-operative urinary symptoms severity. </p>

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Evaluation of Methods for the Extraction and Purification of DNA from the Human Microbiome

Sanqing Yuan, Dora Cohen, Jacques Ravel … (2012)

Background DNA extraction is an essential step in all cultivation-independent approaches to characterize microbial diversity, including that associated with the human body. A fundamental challenge in using these approaches has been to isolate DNA that is representative of the microbial community sampled. Methodology/Principal Findings In this study, we statistically evaluated six commonly used DNA extraction procedures using eleven human-associated bacterial species and a mock community that contained equal numbers of those eleven species. These methods were compared on the basis of DNA yield, DNA shearing, reproducibility, and most importantly representation of microbial diversity. The analysis of 16S rRNA gene sequences from a mock community showed that the observed species abundances were significantly different from the expected species abundances for all six DNA extraction methods used. Conclusions/Significance Protocols that included bead beating and/or mutanolysin produced significantly better bacterial community structure representation than methods without both of them. The reproducibility of all six methods was similar, and results from different experimenters and different times were in good agreement. Based on the evaluations done it appears that DNA extraction procedures for bacterial community analysis of human associated samples should include bead beating and/or mutanolysin to effectively lyse cells.

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The Clinical Urine Culture: Enhanced Techniques Improve Detection of Clinically Relevant Microorganisms.

Travis Price, Tanaka Dune, Evann Hilt … (2016)

Enhanced quantitative urine culture (EQUC) detects live microorganisms in the vast majority of urine specimens reported as "no growth" by the standard urine culture protocol. Here, we evaluated an expanded set of EQUC conditions (expanded-spectrum EQUC) to identify an optimal version that provides a more complete description of uropathogens in women experiencing urinary tract infection (UTI)-like symptoms. One hundred fifty adult urogynecology patient-participants were characterized using a self-completed validated UTI symptom assessment (UTISA) questionnaire and asked "Do you feel you have a UTI?" Women responding negatively were recruited into the no-UTI cohort, while women responding affirmatively were recruited into the UTI cohort; the latter cohort was reassessed with the UTISA questionnaire 3 to 7 days later. Baseline catheterized urine samples were plated using both standard urine culture and expanded-spectrum EQUC protocols: standard urine culture inoculated at 1 μl onto 2 agars incubated aerobically; expanded-spectrum EQUC inoculated at three different volumes of urine onto 7 combinations of agars and environments. Compared to expanded-spectrum EQUC, standard urine culture missed 67% of uropathogens overall and 50% in participants with severe urinary symptoms. Thirty-six percent of participants with missed uropathogens reported no symptom resolution after treatment by standard urine culture results. Optimal detection of uropathogens could be achieved using the following: 100 μl of urine plated onto blood (blood agar plate [BAP]), colistin-nalidixic acid (CNA), and MacConkey agars in 5% CO2 for 48 h. This streamlined EQUC protocol achieved 84% uropathogen detection relative to 33% detection by standard urine culture. The streamlined EQUC protocol improves detection of uropathogens that are likely relevant for symptomatic women, giving clinicians the opportunity to receive additional information not currently reported using standard urine culture techniques.

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The female urinary microbiome in urgency urinary incontinence.

Meghan Pearce, Michael Zilliox, Amy Rosenfeld … (2015)

The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes.