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Yurick S, Ray S, El-Nashar S, Brennand E, Kim-Fine S, Sanaee M, Regan S, Geoffrion R, Occhino J, Hijaz A, Sheyn D. Prediction of Postoperative Urinary Tract Infection Following Benign Gynecologic Surgery. Int Urogynecol J 2024; 35:1035-1043. [PMID: 38625604 DOI: 10.1007/s00192-024-05773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to develop a prediction model for urinary tract infection (UTI) after pelvic surgery. METHODS We utilized data from three tertiary care centers of women undergoing pelvic surgery. The primary outcome was a UTI within 8 weeks of surgery. Additional variables collected included procedural data, severity of prolapse, use of mesh, anti-incontinence surgery, EBL, diabetes, steroid use, estrogen use, postoperative catheter use, PVR, history of recurrent UTI, operative time, comorbidities, and postoperative morbidity including venous thromboembolism, surgical site infection. Two datasets were used for internal validation, whereas a third dataset was used for external validation. Algorithms that tested included the following: multivariable logistic regression, decision trees (DTs), naive Bayes (NB), random forest (RF), gradient boosting (GB), and multilayer perceptron (MP). RESULTS For the training dataset, containing both University of British Columbia and Mayo Clinic Rochester data, there were 1,657 patients, with 172 (10.4%) UTIs; whereas for the University of Calgary external validation data, there were a total of 392 patients with a UTI rate of 16.1% (n = 63). All models performed well; however, the GB, DT, and RF models all had an area under the curve (AUC) > 0.97. With external validation the model retained high discriminatory ability, DT: AUC = 0.88, RF: AUC = 0.88, and GB: AUC = 0.90. CONCLUSIONS A model with high discriminatory ability can predict UTI within 8 weeks of pelvic surgery. Future studies should focus on prospective validation and application of randomized trial models to test the utility of this model in the prevention of postoperative UTI.
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Affiliation(s)
- Sarah Yurick
- Case Western Reserve University College of Engineering, Cleveland, OH, USA
| | - Soumya Ray
- Case Western Reserve University College of Engineering, Cleveland, OH, USA
| | | | | | | | - May Sanaee
- University of Alberta, Edmonton, AB, Canada
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Laus K, Eng S, Nguyen JN. Impact of Preoperative Urinary Tract Infection Screening in Asymptomatic Women Undergoing Midurethral Sling. Int Urogynecol J 2024; 35:423-430. [PMID: 38180507 DOI: 10.1007/s00192-023-05716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION There is limited information regarding the utility of preoperative urine culture (Ucx) screening to decrease postoperative UTI rates following midurethral sling (MUS). HYPOTHESIS The primary objective of this study was to determine if the rate of postoperative UTI within the first 6 weeks after surgery is lower in women undergoing MUS when preoperative Ucx is obtained compared to when it is not. Secondary objectives were to determine clinical factors associated with postoperative UTI risk. METHODS This is a retrospective cohort study of women who did not have symptoms of or a diagnosis of cystitis at the time of their preoperative evaluation and are undergoing MUS. Patients were grouped into those who had preoperative Ucx screening within 6 weeks preceding surgery and those who did not. UTI rates 6 weeks following surgery were compared between groups. Additionally, factors impacting the risk of developing a UTI within 6 weeks of surgery were assessed. RESULTS Among 661 patients, 13.2% had a UTI within the first 6 weeks. There was no significant difference in UTI rates between those who did and did not have preoperative Ucx, respectively (14.9% vs 10.2%, p = 0.09). On multivariable analysis, current smoker status (OR 3.02, 95% CI 1.10-8.26), history of recurrent UTI (OR 3.00, 95% CI 1.14-7.86), and requiring postoperative SIC (OR 8.75, 95% CI 1.83-41.74) were independently associated with a UTI within 6 weeks of MUS. CONCLUSION Obtaining preoperative Ucx in asymptomatic women prior to MUS does not appear to be associated with lower postoperative UTIs rates within 6 weeks of surgery.
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Affiliation(s)
- Katharina Laus
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente Downey Medical Center, Downey, CA, USA.
| | - Sarah Eng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John N Nguyen
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente Downey Medical Center, Downey, CA, USA
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Mann GK, Koenig NA, Lee T, Geoffrion R. Reducing urinary tract infection in female pelvic surgery: A retrospective cohort study. Int J Gynaecol Obstet 2023; 163:639-644. [PMID: 37243324 DOI: 10.1002/ijgo.14892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/30/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare prebundle versus postbundle implementation urinary tract infection (UTI) rates among inpatients within 6 weeks of clean-contaminated pelvic reconstructive surgery. METHODS The authors conducted a retrospective cohort study from September 2019 to December 2021 at a tertiary hospital. The bundle strategy included the following: universal preoperative UTI check with treatment if positive, replacing prolonged postoperative voiding trials on the ward with earlier discharge and indwelling catheter removal by a nurse continence advisor the next day, and daily cranberry extract for 6 weeks postoperatively. UTI was defined as positive urine culture (≥100 000 colony-forming unit per mL) in a symptomatic patient. Data analysis involved hypothesis testing and logistic regression. RESULTS The authors reviewed 132 postbundle inpatient charts and retained 93 for analyses. The results were compared with 204 prebundle inpatient charts. The rate of postoperative UTI decreased from 17.6% in the prebundle group to 6.5% after bundle implementation (P = 0.01). The adjusted odds ratio for postbundle versus prebundle likelihood of UTI was 0.35 (95% confidence interval, 0.13-0.98; P = 0.045). Significantly more postbundle patients compared with prebundle patients were discharged home on the first day postoperatively (76.3% vs. 37.7%, P < 0.001). CONCLUSIONS A clinical bundle can significantly decrease both UTI rates and hospital stay after pelvic reconstructive surgery.
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Affiliation(s)
- Gurkiran K Mann
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nicole A Koenig
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Jung CE, Chen LH, Brubaker LT, Menefee SA. Urinary Tract Infections After Urogynecologic Surgery: Risk Factors, Timeline, and Uropathogens. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:632-640. [PMID: 36701315 DOI: 10.1097/spv.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Urinary tract infection (UTI) is a common and potentially avoidable postoperative (PO) adverse event after urogynecologic surgery. Understanding pathophysiology will help prevent the associated morbidity of the disease and treatment of PO-UTI. OBJECTIVE The objective of this study is to determine the following: (1) risk factors for both PO-UTI and PO recurrent UTI (RUTI) after urogynecologic surgery, (2) temporal distribution of UTI, and (3) uropathogen identification. STUDY DESIGN Women undergoing urogynecologic surgery were retrospectively reviewed. Urinary tract infection was defined by culture or antibiotic prescription for symptoms. Recurrent UTI was defined as occurring outside a 6-week perioperative period. The χ 2 test or Fischer exact and Student t tests or Mann-Whitney U test were used as appropriate. Individual odds ratio (OR), 95% confidence interval [CI], and sequential multivariable logistic regression were calculated. Statistical significance was set at P < 0.05. RESULTS The 6-week PO-UTI rate after 33,626 procedures was 12.9%. Recurrent UTI increased from 3.7% preoperatively to 4.4% postoperatively ( P < 0.001). A 6-week preoperative UTI and RUTI increased the risk of 6-week PO-UTI (OR, 1.65; 95% CI < 1.26-2.16; P = 0.001 and OR, 2.19; 95% CI, 1.84-2.62; P < 0.001, respectively) and PO-RUTI (OR, 2.95; 95% CI, 2.11-4.11; P < 0.001 and OR, 6.79; 95% CI, 5.61-8.23; P < 0.001, respectively). Compared with pelvic organ prolapse (POP) surgery only, stress urinary incontinence (SUI) surgery (OR 1.57[1.30-1.89]), and combined POP/SUI surgery (OR, 1.36; 95% CI, 1.13-1.63]) increased the risk of PO-RUTI ( P < 0.001). Urinary tract infection within 1 week preoperatively was protective against 6-week PO-UTI (OR, 0.68; 95% CI, 0.48-0.97; P = 0.035). No perioperative factors were protective of PO-RUTI. CONCLUSIONS The PO-RUTI rate in the first year after urogynecologic surgery is low; however, SUI procedures may increase PO-RUTI risk. Potentially, modifiable risk factors for both PO-UTI and PO-RUTI include UTI diagnosis within 6 weeks preoperatively or preoperative RUTI diagnosis. Retesting women the week before surgery to ensure adequate treatment of preoperative UTI may reduce 6-week PO-UTI.
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Affiliation(s)
| | - Lie H Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Linda T Brubaker
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla
| | - Shawn A Menefee
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente, Southern California, San Diego
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Wang R, Scutari T, Tunitsky-Bitton E. Implementation of a Clinical Protocol to Reduce Urinary Tract Infections Among Women With Urinary Retention After Pelvic Reconstructive Surgery: A Prospective Quality Improvement Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:134-140. [PMID: 36565922 DOI: 10.1016/j.jogc.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We implemented and assessed a clinical practice quality improvement protocol aimed at decreasing postoperative urinary tract infections (UTIs) among patients with transurethral catheters. METHODS This was a quality improvement study with pre- and post-intervention comparisons. Patients requiring postoperative transurethral catheters underwent 3 interventions: (1) shortening the time from surgery to repeat voiding trials to 3-5 days for pelvic reconstructive surgeries and to 1-3 days for mid-urethral slings, (2) avoiding routine urine cultures at the time of voiding trials, and (3) recommending 2 L of water intake daily until 3 days after the voiding trial. The primary outcome was the percentage of patients receiving antibiotics for UTIs within 6 weeks. Secondary outcomes included rates of failing office voiding trials, UTI symptoms/cultures, adherence to hydration, and health care resource utilization. RESULTS We included 31 patients before and 40 patients after the intervention. The 2 cohorts had similar demographic and clinical characteristics. Among patients requiring catheterization, rates of antibiotic treatment for UTIs decreased from 65% to 40% after the intervention (P = 0.04). UTI symptoms and urine cultures sent for analysis decreased significantly (P = 0.04 and P = 0.005, respectively). There was high adherence (84%) to increased hydration. Rates of failing office voiding trials remained similar. The number of phone calls decreased by 43% (P = 0.003), and there was no increase in office or emergency department visits. Multivariate regression showed that UTIs were 2.04 times more likely before than after the intervention. CONCLUSION Our quality improvement intervention was practical to implement and effective in reducing postoperative UTIs among patients with urinary catheters.
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Affiliation(s)
- Rui Wang
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT.
| | - Taylor Scutari
- University of Connecticut School of Medicine, Farmington, CT
| | - Elena Tunitsky-Bitton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
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Intraoperative Gentamicin Intravesical Instillation for Prevention of Urinary Tract Infection After Urogynecologic Surgery: A Randomized Controlled Trial. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:825-833. [PMID: 36409639 DOI: 10.1097/spv.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Currently available evidence for efficacy of postoperative antibiotics to prevent postoperative urinary tract infection (UTI) conflicts. Oral antibiotics rely on patient adherence and can cause unwanted systemic effects. Gentamicin is a broad-spectrum antibiotic with rapid bactericidal activity and, when administered intravesically, has no systemic absorption through intact urothelium. OBJECTIVE We aimed to determine whether a single intravesical instillation of gentamicin at the conclusion of urogynecologic surgery would reduce the proportion of women treated for UTI within 6 weeks postoperatively compared with sham instillation. STUDY DESIGN This was a multicenter, randomized (stratified by study site, route of prolapse repair ±suburethral sling, with balanced 1:1 randomization), participant-masked, sham-controlled, study. The primary outcome was the proportion of participants treated with antibiotics for UTI within 6 weeks postoperatively. An adjusted multivariable logistic regression model was constructed to determine predictors of postoperative UTI treatment. RESULTS Three hundred seventy participants were randomized (gentamicin, 185; sham, 185), and data from 363 participants were analyzed (gentamicin, 183; sham, 180). Nineteen women in the gentamicin group and 20 women in the sham group were treated for UTI within 6 weeks postoperatively (10.4% vs 11.1%, P = 0.87). There were no adverse events related to the instillations. Increasing age (odds ratio, 1.028 [1.000-1.057]) and number of intraoperative transurethral instrumentations (odds ratio, 1.342 [1.080-1.668]) were independent predictors of postoperative UTI treatment. CONCLUSIONS In women undergoing urogynecologic surgery, postoperative intravesical gentamicin did not reduce the incidence of postoperative UTI. The number of intraoperative transurethral instrumentations is an important, potentially modifiable risk factor for postoperative UTI treatment.
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Perioperative outcomes of laparoscopic sacrocolpopexy with and without hysterectomy: a secondary analysis of the National Surgical Quality Improvement Program Database. Int Urogynecol J 2021; 33:1889-1895. [PMID: 33646349 DOI: 10.1007/s00192-021-04675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to compare 30-day perioperative complications in women undergoing minimally invasive sacrocolpopexy with and without a concomitant hysterectomy. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified women undergoing minimally invasive sacrocolpopexy between 2014 and 2018. Women were then stratified into two groups: sacrocolpopexy only and sacrocolpopexy + hysterectomy. The primary outcome was the occurrence of any 30-day postoperative complication. Group comparisons were performed using Student's t test, Mann-Whitney U test, and Chi-squared test. Multivariate logistic regression was used to identify independent factors associated with the occurrence of any complication. RESULTS A total of 8,553 women underwent laparoscopic sacrocolpopexy, 5,123 (59.9%) of whom had a concomitant hysterectomy. Median operative time was longer in women who had sacrocolpopexy + hysterectomy compared with sacrocolpopexy alone (185 [129-241] versus 172 [130-224] min, p < 0.001). The rate of any 30-day postoperative complication did not differ between groups (sacrocolpopexy + hysterectomy 5.5% versus sacrocolpopexy alone 5.8%, p = 0.34). Likewise, organ space, deep, and superficial surgical site infections did not differ between groups. There was also no difference in reoperation or readmission rates between groups. On multivariate logistic regression, sacrocolpopexy + hysterectomy were not associated with increased odds of 30-day postoperative complications relative to women who underwent sacrocolpopexy alone. CONCLUSIONS Complication rates during the first 30 days after minimally invasive sacrocolpopexy are low and concomitant hysterectomy is not associated with increased risks of 30-day complications after surgery.
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Antibiotic Prophylaxis in Pelvic Floor Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00601-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The discovery of bacteria in the female urinary bladder has fundamentally changed current dogma regarding the urinary tract and related urinary disorders. Previous research characterized many of the bacterial components of the female urinary tract, but the viral fraction of this community is largely unknown. Viruses within the human microbiota far outnumber bacterial cells, with the most abundant viruses being those that infect bacteria (bacteriophages). Similar to observations within the microbiota of the gut and oral cavity, preliminary surveys of the urinary tract and bladder microbiota indicate a rich diversity of uncharacterized bacteriophage (phage) species. Phages are vital members of the microbiota, having critical roles in shaping bacterial metabolism and community structure. Although phages have been discovered in the urinary tract, such as phages that infect Escherichia coli, sampling them is challenging owing to low biomass, possible contamination when using non-invasive methods and the invasiveness of methods that reduce the potential for contamination. Phages could influence bladder health, but an understanding of the association between phage communities, bacterial populations and bladder health is in its infancy. However, evidence suggests that phages can defend the host against pathogenic bacteria and, therefore, modulation of the microbiome using phages has therapeutic potential for lower urinary tract symptoms. Furthermore, as natural predators of bacteria, phages have garnered renewed interest for their use as antimicrobial agents, for instance, in the treatment of urinary tract infections.
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8 versus 12 weeks of percutaneous tibial nerve stimulation and response predictors for overactive bladder. Int Urogynecol J 2020; 31:905-914. [DOI: 10.1007/s00192-019-04191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/14/2019] [Indexed: 01/16/2023]
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Sanaee MS, Pan K, Lee T, Koenig NA, Geoffrion R. Urinary tract infection after clean-contaminated pelvic surgery: a retrospective cohort study and prediction model. Int Urogynecol J 2019; 31:1821-1828. [PMID: 31673797 DOI: 10.1007/s00192-019-04119-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/05/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Postoperative urinary tract infection (UTI) leads to increased patient morbidity and health care costs. A prediction model may identify patients at highest risk for UTI development. Our primary objective was to determine the rate of UTI in the first 6 weeks after benign gynecologic surgery. Our secondary objective was to identify risk factors and build a predictive model for postoperative UTI. METHODS We reviewed 310 patient records, which represent all patients who underwent clean-contaminated surgery at a tertiary center (2016-2017). UTI was defined as positive urine culture (> 100,000,000 CFU/l) in a symptomatic patient. Pre-, intra- and postoperative variables were collected. The relation between these variables and UTI was assessed through logistic regression. A clinical prediction model was built. RESULTS Patients' mean age was 58.5 years and mean body mass index was 27.5 kg/m2. Most were inpatients (65.8%) and 269 had urogynecologic procedures, with the remainder undergoing pelvic surgery for other indications. The most common operation was vaginal reconstruction for prolapse (59.7%), associated with concomitant synthetic midurethral sling in 1/3 cases. Forty patients (12.9%) developed UTI. Multivariate prediction modeling showed increasing age (OR 1.33, CI 1.01-1.75), increasing number of procedures (OR 1.42, CI 1.14-1.78) and prolonged voiding dysfunction (OR 3.78, CI 1.66-8.60) to be significant UTI predictors. CONCLUSIONS Urinary tract infection in the first 6 weeks after complex pelvic surgery is common. Our prediction model identifies that patients who are older women, have prolonged voiding dysfunction and have a greater number of concomitant pelvic floor surgeries have higher risk of postoperative UTI.
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Affiliation(s)
- May Sara Sanaee
- Department of Obstetrics and Gynecology, University of Alberta, 5S118 Lois Hole Hospital for Women, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.
| | - Kathy Pan
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada
| | - Nicole A Koenig
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada
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Johnson G, Putonti C. Genome Sequence of Pseudomonas Phage UMP151, Isolated from the Female Bladder Microbiota. Microbiol Resour Announc 2019; 8:e00853-19. [PMID: 31416880 PMCID: PMC6696655 DOI: 10.1128/mra.00853-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022] Open
Abstract
A temperate bacteriophage, designated UMP151, was isolated from a Pseudomonas aeruginosa strain from a catheterized urine sample of a woman with overactive bladder (OAB) symptoms. The 41,303-bp genome sequence of Pseudomonas phage UMP151 exhibits sequence similarity to prophage and lytic phage sequences isolated from other areas of the human body.
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Affiliation(s)
- Genevieve Johnson
- Bioinformatics Program, Loyola University Chicago, Chicago, Illinois, USA
| | - Catherine Putonti
- Bioinformatics Program, Loyola University Chicago, Chicago, Illinois, USA
- Department of Biology, Loyola University Chicago, Chicago, Illinois, USA
- Department of Computer Science, Loyola University Chicago, Chicago, Illinois, USA
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois, USA
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Postoperative urinary tract infection after urogynecologic surgery: timing and uropathogens. Int Urogynecol J 2019; 31:1621-1626. [PMID: 31359115 DOI: 10.1007/s00192-019-04061-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/16/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Although postoperative urinary tract infections (UTIs) after urogynecologic surgery are a common adverse event, there is no standardized postoperative time period used to assess this outcome, and the uropathogens unique to this sub-population of patients have not been well described. Our objective is to describe the timing and uropathogens of postoperative UTI after urogynecologic surgery. METHODS This retrospective study analyzed postoperative UTI occurring within 90 days following urogynecologic procedures from November 2013 to January 2018 at a single academic institution. Postoperative UTI was defined as any uropathogen growth from standard urine culture. Continuous variables were compared with independent samples t-test and categorical variables with chi-square with Bonferonni corrections as appropriate. RESULTS One hundred and two of 1085 (9.4%) patients experienced UTI; 63.7% occurred within 6 weeks and 78.4% within 8 weeks; 36.3% of UTIs occurred at a time period of 6 weeks to 90 days. Most commonly isolated uropathogens were Escherichia coli (47.8%) with an additional 11.2% extended-spectrum beta-lactamase (ESBL) Escherichia coli. Other bacteria included Enterococcus faecalis (10.4%), Klebsiella pneumoniae (9%), and one culture each for ESBL Klebsiella pneumoniae and vancomycin-resistant (VRE) Enterococcus faecium. CONCLUSIONS More than one third of UTIs after urogynecologic surgery occur between 6 weeks and 90 days postoperatively. A plateau of UTI incidence occurs at 8 weeks, a time period at which 78.4% of all UTIs were captured. Escherichia coli was the most commonly isolated uropathogen, and multi-drug-resistant bacteria were implicated in 12.8% of UTIs.
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Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice. J Minim Invasive Gynecol 2019; 26:312-320. [DOI: 10.1016/j.jmig.2018.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/16/2018] [Accepted: 08/24/2018] [Indexed: 11/23/2022]
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Bajic P, Wolfe AJ, Gupta GN. The Urinary Microbiome: Implications in Bladder Cancer Pathogenesis and Therapeutics. Urology 2019; 126:10-15. [PMID: 30615894 DOI: 10.1016/j.urology.2018.12.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/20/2018] [Accepted: 12/29/2018] [Indexed: 01/05/2023]
Abstract
Recent investigation has proven that the bladder is not sterile. However, the implications of this finding in the pathophysiology and management of urothelial cell carcinoma have not been fully described. In this review, we summarize the literature relating to the urinary and gastrointestinal microbiomes in the context of urothelial cell carcinoma. The bladder microbiome may relate to urothelial cell carcinoma pathogenesis/progression, act as a noninvasive and modifiable urinary biomarker and have implications in treatment using immunotherapy agents such as intravesical bacillus Calmette-Guerin. Investigators should continue to optimize techniques to characterize this intriguing new area of human health.
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Affiliation(s)
- Petar Bajic
- Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Gopal N Gupta
- Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL; Departments of Surgery and Radiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
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Indwelling Versus Immediate Removal of Transurethral Catheter After Robotic Sacrocolpopexy: A Randomized Clinical Trial. Female Pelvic Med Reconstr Surg 2018; 26:617-621. [PMID: 30325784 DOI: 10.1097/spv.0000000000000646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study evaluates the necessity and effect of an indwelling transurethral catheter in the early postoperative period following a robotic-assisted laparoscopic sacrocolpopexy. METHODS This was a randomized clinical trial of patients who underwent a robotic sacrocolpopexy for pelvic organ prolapse. Patients were randomized to have their transurethral catheter removed 6 hours postoperative (intervention group) or the morning following surgery (control group). Our primary outcome was to compare the number of patients diagnosed with postoperative incomplete bladder empyting in each group. A sample size of 36 patients per group was needed to detect a 25% difference between the 2 groups. Anticipating a 20% patient withdrawal rate, we estimated that we would need a total of 88 participants. Outcome variable was analyzed using χ test, Fisher exact test, Mann-Whitney U test, 2-proportions test, and 2-sample t test. RESULTS From December 2015 through May 2017, 88 women were randomized and analyzed: 44 in the intervention group and 44 in the control group. Women in the intervention group were more likely to be diagnosed with incomplete bladder emptying, 14 (31%) of 44, compared with the control group, 2 (4.5%) of 44, P <0.001. Rate of urinary tract infections within the 30-day postoperative period was also increased in the intervention group, 4 (9%) of 44, compared with 0 in the control group. Postoperative complications were similar between groups. CONCLUSIONS In women undergoing a robotic sacrocolpopexy, early transurethral catheter removal (6 hours postoperative) is associated with an increased rate of incomplete bladder emptying, recatheterization, and urinary tract infections.
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Urinary microbes and postoperative urinary tract infection risk in urogynecologic surgical patients. Int Urogynecol J 2018; 29:1797-1805. [PMID: 30267143 DOI: 10.1007/s00192-018-3767-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Women have a 20% risk of developing a urinary tract infection (UTI) following urogynecologic surgery. This study assessed the association of postoperative UTI with bacteria in preoperative 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 ribosomal RNA (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 postoperative UTI (positive/negative). Characteristics of bladder, vaginal, and perineal microbiomes were assessed to identify factors associated with postoperative UTI. RESULTS Eighty-seven percent of the 104 surgical patients with pelvic organ prolapse/urinary incontinence (POP/UI) were white; 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 < 2.2-16) differences in age, microbes, and postoperative UTI risk. Postoperative UTI was most frequently 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 Postoperative UTI risk appears to be associated with preoperative bladder microbiome composition, where an abundance of L. iners appears to protect against postoperative UTI.
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Impact of positive preoperative urine cultures before pediatric lower urinary tract reconstructive surgery. Pediatr Surg Int 2018; 34:983-989. [PMID: 30069752 DOI: 10.1007/s00383-018-4306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Children who undergo lower urinary tract reconstruction (LUTR) often have asymptomatic bacteriuria or recurrent urinary tract infections (UTI). We aimed to determine the prevalence of positive preoperative urine cultures (PPUC) before LUTR and to analyze any impact on postoperative outcomes. METHODS This retrospective review included all pediatric LUTR procedures utilizing bowel segments performed by one surgeon over 2 years. Preoperative cultures were obtained 1-2 days before surgery. Baseline characteristics and 90-day infection/readmission rates between patients with and without PPUC were compared using descriptive statistics, Fisher's exact, and Mann-Whitney tests with significance p < 0.05. RESULTS 54 patients with mean age 10.1 ± 5.6 years underwent LUTR procedures using bowel including continent catheterizable channel (85%), enterocystoplasty (81%), and/or urinary diversion (9%). PPUC was present in 28 patients (52%). Postoperatively, 20% had inpatient infections, including eight UTI, four surgical site infections, and two bloodstream infections with no difference between those with or without PPUC. Within 90 days of discharge, 28% of patients were readmitted to the hospital, and there was no difference between groups. Postoperative urine cultures were positive in 83% of patients within 90 days. CONCLUSIONS Half of the patients undergoing LUTR have PPUC, but it does not increase the risk of postoperative infections or hospital readmissions. We believe complex LUTR can be safely performed in patients with PPUC.
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Fok CS, Gao X, Lin H, Thomas-White KJ, Mueller ER, Wolfe AJ, Dong Q, Brubaker L. Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients. Int Urogynecol J 2018; 29:1765-1771. [PMID: 30116843 DOI: 10.1007/s00192-018-3732-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Persistent and de novo symptoms decrease satisfaction after urogynecologic surgery. We investigated whether the preoperative bladder microbiome is associated with urinary symptoms prior to and after urogynecologic surgery. METHODS One hundred twenty-six participants contributed responses to the validated OABq symptom questionnaire. Catheterized (bladder) urine samples and vaginal and perineal swabs were collected immediately preoperatively. Bacterial DNA in the urine samples and swabs was sequenced and classified. RESULTS Preoperative 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: Atopobium vaginae and Finegoldia magna. The presence of Atopobium vaginae in bladder urine also was correlated with its presence in either the vagina or perineum. CONCLUSIONS Two specific bacterial species detected in bladder urine, Atopobium vaginae and Finegoldia magna, are associated with preoperative urinary symptom severity in women undergoing POP/SUI surgery. The reservoir for Atopobium vaginae may be adjacent pelvic floor niches. This observation should be validated in a larger cohort to determine whether there is a microbiologic etiology for certain preoperative urinary symptoms.
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Affiliation(s)
- Cynthia S Fok
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Xiang Gao
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Huaiying Lin
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Krystal J Thomas-White
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.,, Menlo Park, CA, USA
| | - Elizabeth R Mueller
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Qunfeng Dong
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Linda Brubaker
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, 9500 Gilman Drive MC 0971, La Jolla, CA, 92121, USA.
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Thomas-White K, Forster SC, Kumar N, Van Kuiken M, Putonti C, Stares MD, Hilt EE, Price TK, Wolfe AJ, Lawley TD. Culturing of female bladder bacteria reveals an interconnected urogenital microbiota. Nat Commun 2018; 9:1557. [PMID: 29674608 PMCID: PMC5908796 DOI: 10.1038/s41467-018-03968-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
Metagenomic analyses have indicated that the female bladder harbors an indigenous microbiota. However, there are few cultured reference strains with sequenced genomes available for functional and experimental analyses. Here we isolate and genome-sequence 149 bacterial strains from catheterized urine of 77 women. This culture collection spans 78 species, representing approximately two thirds of the bacterial diversity within the sampled bladders, including Proteobacteria, Actinobacteria, and Firmicutes. Detailed genomic and functional comparison of the bladder microbiota to the gastrointestinal and vaginal microbiotas demonstrates similar vaginal and bladder microbiota, with functional capacities that are distinct from those observed in the gastrointestinal microbiota. Whole-genome phylogenetic analysis of bacterial strains isolated from the vagina and bladder in the same women identifies highly similar Escherichia coli, Streptococcus anginosus, Lactobacillus iners, and Lactobacillus crispatus, suggesting an interlinked female urogenital microbiota that is not only limited to pathogens but is also characteristic of health-associated commensals. The female bladder seems to harbor a poorly characterized indigenous microbiota. Here, the authors isolate and genome-sequence 149 bacterial strains from catheterized urine of 77 women, generating a culture collection representing two thirds of the bacterial diversity within the samples.
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Affiliation(s)
- Krystal Thomas-White
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Samuel C Forster
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, CB10 1SA, UK.,Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Molecular and Translational Sciences, Monash University, Clayton, VIC, 3800, Australia
| | - Nitin Kumar
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, CB10 1SA, UK
| | - Michelle Van Kuiken
- Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Catherine Putonti
- Department of Biology, Loyola University Chicago, Chicago, IL, 60660, USA.,Department of Computer Science, Loyola University Chicago, Chicago, IL, 60660, USA.,Bioinformatics Program, Loyola University Chicago, Chicago, IL, 60660, USA
| | - Mark D Stares
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, CB10 1SA, UK
| | - Evann E Hilt
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Travis K Price
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA.
| | - Trevor D Lawley
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, CB10 1SA, UK.
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Clancy AA, Mallick R, Breau RH, Khalil H, Hickling DR. Complications after minimally invasive sacrocolpopexy with and without concomitant incontinence surgery: A National Surgical Quality Improvement Program (NSQIP) database study. Neurourol Urodyn 2018; 37:2234-2241. [PMID: 29635701 DOI: 10.1002/nau.23574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/27/2018] [Indexed: 11/10/2022]
Abstract
AIMS To compare surgical complications for patients having minimally invasive sacrocolpopexy (MISCP) with concomitant incontinence procedure, to those having MISCP alone. METHODS Patients undergoing MISCP with and without a concomitant incontinence procedure between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. The main outcome of interest was a composite of surgical site infection, bleeding requiring blood transfusion, return to the operating room within 30 days, and surgical stay >48 h. Log-binomial regression was used to identify independent risk factors for the outcome and to generate adjusted effect measures for variables of interest. RESULTS Seven thousand ninety-seven women met the inclusion criteria, of which 2433 (34%) underwent a concomitant incontinence procedure. Patients having incontinence procedures were slightly older (59 ± 11 vs 58 ± 12, P < 0.0001) and had longer total operating time (225 IQR 170-267 vs 184 IQR 120-232 min, P < 0.0001). Pre-operative steroid use, wound class III/IV (vs I/II), and longer operative time were independent predictors of the composite outcome. After adjusting for baseline patient characteristics and co-morbidities, no association was observed between concomitant incontinence procedure and the composite outcome (adjusted RR 0.87, 95%CI 0.65-1.18) but there was an increased likelihood of urinary tract infection (adjusted RR 2.47 95%CI 1.89-3.27). CONCLUSIONS Despite being associated with a longer operative time, performing an incontinence procedure at the time of MSCIP was not associated with an increased risk of clinically important surgical complications other than urinary tract infection.
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Affiliation(s)
- Aisling A Clancy
- Department of Obstetrics and Gynecology, Division of Urogynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodney H Breau
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Surgery, Division of Urology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hisham Khalil
- Department of Obstetrics and Gynecology, Division of Urogynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Duane R Hickling
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Surgery, Division of Urology, The Ottawa Hospital, Ottawa, Ontario, Canada
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Polin MR, Kawasaki A, Amundsen CL, Weidner AC, Siddiqui NY. Do Mixed-Flora Preoperative Urine Cultures Matter? South Med J 2017; 110:426-429. [DOI: 10.14423/smj.0000000000000659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Risk Factors for Urinary Tract Infection following Mid Urethral Sling Surgery. J Urol 2017; 197:1268-1273. [DOI: 10.1016/j.juro.2016.12.093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/23/2022]
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Brubaker L, Wolfe AJ. The Female Urinary Microbiota/Microbiome: Clinical and Research Implications. Rambam Maimonides Med J 2017; 8:RMMJ.10292. [PMID: 28467757 PMCID: PMC5415361 DOI: 10.5041/rmmj.10292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The changing science of the urinary microbiota and microbiome has both clinical and research implications. This review paper provides an overview of the state of this science, as well as a discussion of the potential for prevention, diagnosis, and treatment of human disease. The history of techniques used for clinical detection of infection are placed into context along with the modern methods of bacterial detection and identification.
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Affiliation(s)
- Linda Brubaker
- Department of Obstetrics & Gynecology, University of California San Diego, CA, USA
- Department of Urology, University of California San Diego, CA, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, IL, USA
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Evaluation of the urinary microbiota of women with uncomplicated stress urinary incontinence. Am J Obstet Gynecol 2017; 216:55.e1-55.e16. [PMID: 27498309 DOI: 10.1016/j.ajog.2016.07.049] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Female urinary microbiota are associated with urgency urinary incontinence and response to medication. The urinary microbiota of women with stress urinary incontinence has not been described. OBJECTIVE We sought to study the cross-sectional relationships between urinary microbiota features and demographic and clinical characteristics of women undergoing stress urinary incontinence surgery. STUDY DESIGN Preoperative urine specimens were collected from women without urinary tract infection and were available from 197 women (174 voided, 23 catheterized) enrolled in a multicenter prospective randomized trial, the Value of Urodynamic Evaluation study. Demographic and clinical variables were obtained including stress and urgency urinary incontinence symptoms, menopausal status, and hormone use. The bacterial composition of the urine was qualitatively assessed by sequencing the bacterial 16S ribosomal RNA gene. Phylogenetic relatedness and microbial alpha diversity were compared to demographics and symptoms using generalized estimating equation models. RESULTS The majority of 197 urine samples (86%) had detectable bacterial DNA. Bacterial diversity was significantly associated with higher body mass index (P = .02); increased Medical, Epidemiologic, and Social Aspects of Aging urge index score (P = .04); and hormonal status (P < .001). No associations were detected with stress urinary incontinence symptoms. Increased diversity was also associated with a concomitant lower frequency of Lactobacillus in hormone-negative women. CONCLUSION Women undergoing stress urinary incontinence surgery have detectable urinary microbiota. This cross-sectional analysis revealed that increased diversity of the microbiota was associated with urgency urinary incontinence symptoms, hormonal status, and body mass index. In contrast, the female urinary microbiota were not associated with stress urinary incontinence symptoms.
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27
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Losada L, Amundsen CL, Ashton-Miller J, Chai T, Close C, Damaser M, DiSanto M, Dmochowski R, Fraser MO, Kielb SJ, Kuchel G, Mueller ER, Parker-Autry C, Wolfe AJ, Mallampalli MP. Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span. J Womens Health (Larchmt) 2016; 25:1086-1096. [PMID: 27285829 PMCID: PMC5116700 DOI: 10.1089/jwh.2016.5895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life.
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Affiliation(s)
- Liliana Losada
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
| | - Cindy L Amundsen
- 2 Departments of Obstetrics and Gynecology and Surgery, Duke University , Durham, North Carolina
| | - James Ashton-Miller
- 3 Department of Biomechanical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Toby Chai
- 4 Department of Urology, Yale School of Medicine , New Haven, Connecticut
| | - Clare Close
- 5 Close Pediatric Urology , Las Vegas, Nevada
| | - Margot Damaser
- 6 Department of Biomedical Engineering, Cleveland Clinic and Louis Stokes Cleveland VA Medical Center , Cleveland, Ohio
| | - Michael DiSanto
- 7 Department of Biomedical Sciences and Surgery, Cooper Medical School of Rowan University , Camden, New Jersey
| | - Roger Dmochowski
- 8 Department of Urology, Vanderbilt University , Nashville, Tennessee
| | - Matthew O Fraser
- 9 Department of Surgery, Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Stephanie J Kielb
- 10 Department of Urology and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - George Kuchel
- 11 Department of Geriatrics and Gerontology, UConn Center on Aging , Farmington, Connecticut
| | - Elizabeth R Mueller
- 12 Department Obstetrics/Gynecology and Urology, Loyola University Medical Center, Loyola University Chicago , Maywood, Illinois
| | - Candace Parker-Autry
- 13 Department of Obstetrics and Gynecology, Wake Forest University , Baptist Medical Center, Winston-Salem, North Carolina
| | - Alan J Wolfe
- 14 Department of Microbiology and Immunology, Loyola University Chicago , Maywood, Illinois
| | - Monica P Mallampalli
- 1 Scientific Affairs, Society for Women's Health Research (SWHR®) , Washington, District of Columbia
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Nienhouse V, Gao X, Dong Q, Nelson DE, Toh E, McKinley K, Schreckenberger P, Shibata N, Fok CS, Mueller ER, Brubaker L, Wolfe AJ, Radek KA. Interplay between bladder microbiota and urinary antimicrobial peptides: mechanisms for human urinary tract infection risk and symptom severity. PLoS One 2014; 9:e114185. [PMID: 25486068 PMCID: PMC4259481 DOI: 10.1371/journal.pone.0114185] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/05/2014] [Indexed: 12/11/2022] Open
Abstract
Resident bacterial communities (microbiota) and host antimicrobial peptides (AMPs) are both essential components of normal host innate immune responses that limit infection and pathogen induced inflammation. However, their interdependence has not been investigated in the context of urinary tract infection (UTI) susceptibility. Here, we explored the interrelationship between the urinary microbiota and host AMP responses as mechanisms for UTI risk. Using prospectively collected day of surgery (DOS) urine specimens from female pelvic floor surgery participants, we report that the relative abundance and/or frequency of specific urinary microbiota distinguished between participants who did or did not develop a post-operative UTI. Furthermore, UTI risk significantly correlated with both specific urinary microbiota and β-defensin AMP levels. Finally, urinary AMP hydrophobicity and protease activity were greater in participants who developed UTI, and correlated positively with both UTI risk and pelvic floor symptoms. These data demonstrate an interdependency between the urinary microbiota, AMP responses and symptoms, and identify a potential mechanism for UTI risk. Assessment of bacterial microbiota and host innate immune AMP responses in parallel may identify increased risk of UTI in certain populations.
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Affiliation(s)
- Vanessa Nienhouse
- The Burn and Shock Trauma Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Xiang Gao
- Department of Biological Sciences, University of North Texas, Denton, Texas, United States of America
- Department of Computer Science and Engineering, University of North Texas, Denton, Texas, United States of America
| | - Qunfeng Dong
- Department of Biological Sciences, University of North Texas, Denton, Texas, United States of America
- Department of Computer Science and Engineering, University of North Texas, Denton, Texas, United States of America
| | - David E. Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Evelyn Toh
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kathleen McKinley
- Department of Pathology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Paul Schreckenberger
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Pathology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Noriko Shibata
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Cynthia S. Fok
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Obstetrics/Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Urology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Elizabeth R. Mueller
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Obstetrics/Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Urology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Linda Brubaker
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Obstetrics/Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Urology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Alan J. Wolfe
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Katherine A. Radek
- The Burn and Shock Trauma Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- * E-mail:
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Guldberg R, Kesmodel US, Brostrøm S, Kærlev L, Hansen JK, Hallas J, Nørgård BM. Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence: a cohort study. BMJ Open 2014; 4:e004051. [PMID: 24496697 PMCID: PMC3918979 DOI: 10.1136/bmjopen-2013-004051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics before surgery. DESIGN A historical population-based cohort study. SETTING Denmark. PARTICIPANTS Women (age ≥18 years) with a primary surgical procedure for UI from the county of Funen and the Region of Southern Denmark from 1996 throughout 2010. Data on redeemed prescriptions of antibiotics ±365 days from the date of surgery were extracted from a prescription database. MAIN OUTCOME MEASURES Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. RESULTS A total of 2151 women had a primary surgical procedure for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antibiotics for UTI was a strong risk factor for postoperative treatment for UTI, both within 0-60 days (adjusted OR, aOR=2.6 (95% CI 2.0 to 3.5)) and within 61-365 days (aOR=4.5 (95% CI 3.5 to 5.7)). CONCLUSIONS 1 in 4 women undergoing surgery for UI was treated for UTI before surgery, and half of them had a continuing tendency to UTIs after surgery. Use of antibiotics for UTI before surgery was a strong risk factor for antibiotic use after surgery. In women not using antibiotics for UTI before surgery only a minor proportion initiated use after surgery.
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Affiliation(s)
- Rikke Guldberg
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | - Søren Brostrøm
- Department of Hospital Services and Emergency Management, Danish Health and Medicines Authority, Copenhagen, Denmark
| | - Linda Kærlev
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Jesper Kjær Hansen
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Research Unit of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
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Steers WD. This Month in Adult Urology. J Urol 2013. [DOI: 10.1016/j.juro.2013.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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