Urine and colon microbiota in patients with recurrent uncomplicated lower urinary tract infection

Background. The prevalence of urinary tract infections (UTIs) in general and recurrent lower UTIs, in particular, constantly remains at a high level. Currently, more and more researchers are attempting to study the microbial biocenosis of the urinary tract in patients with UTIs in terms of the relationship between UTIs and patient's colon microbiota in order to detail the etiology and pathogenesis of these conditions as an insufficiently studied issue.

Objectives. To study the microbiota of urine and colon, as well as significant correlations in these biotopes.

Materials and methods. 169 patients with recurrent lower UTIs from the Urology Clinic and the Department of Microbiology and Virology No. 1 (Rostov State Medical University) were examined. Average age: 36.2 ± 4.7 years. Midstream urine samples for bacteriological examination was taken in accordance with the rules set out in the Clinical recommendations (2014) exactly observing the preanalytical stage. The study of the colon microbiota as well as the collection of material was carried out in accordance with the rules set forth in the industry standard (OS) OST 915000. 11.0004 - 2003, Order of the Ministry of Health of the Russian Federation No. 231 of 09/09/03. Guided by this standard, the interpretation of the results was conducted. Results' statistical processing was implemented using the SPSS version 23 package.

Results. In patients with recurrent lower UTIs two significant quantitative correlation coefficients were detected. The first correlation coefficient showed inverse correlation between typical E. coli isolated from urine and Eubacterium spp. isolated from feces (r = -0.434, p = 0.009). The second correlation coefficient showed a direct correlation between the amount of Lactobacilli isolated from urine and Coalulase-negative Staphylococci (CoNS) isolated from feces, accordingly (r = -0.434, p = 0.009).

When comparing the frequencies of detection of various microbiota taxa, three significant correlation coefficient were found in the loci under study: between Lactobacilli or Peptococci isolated from urine and CoNS verified in feces (PCC - 0.342, p = 0.031 and PCC - 0.341, p = 0.018, respectively), as well as between Peptococci detected in urine and Enterococci in feces (PCC - 0.349, p = 0.028).

Conclusion. The data we obtained on significant correlation coefficients between microorganisms isolated from urine and colon indirectly confirm the translocation mechanism. Undoubtedly, further research is needed to study the mechanism of translocation of microorganisms from the intestines and other biotopes into the organs of the urinary system in order to understand the pathogenesis of this common group of diseases.

1. Koves B, Wullt B. The role of the host and the pathogens in urinary tract infection. Eur Urology Suppl. 2016;15:88-94. DOI: 10.1016/j.eursup.2016.04.005

2. Cardwell SM, Crandon JL, Nicolau DP, McClure MH, Nailor MD. Epidemiology and economics of adult patients hospitalized with urinary tract infections. Hosp Pract. 2016;44(1):33-40. DOI: 10.1080/21548331.2016.1133214

3. Hamada Y, Magarifuchi H, Oho M, Kusaba K, Nagasawa Z, Fukuoka M, Yamakuchi H, Urakami T, Aoki Y. Clinical features of enterococcal bacteremia due to ampicillin-susceptible and ampicillin-resistant enterococci: An eight-year retrospective comparison study. Journal of Infection and Chemotherapy. 2015;21(7):527-30. DOI: 10.1016/j.jiac.2015.04.001

4. Alaeva UG, Apolikhina OI, Pushkar DYu, et al., eds. Federal clinical guidelines "Antimicrobial therapy and prevention of infections of the kidneys, urinary tract and male genital organs. Moscow; 2015, 2017. (in Russ.)

5. Clinical recommendations "Bacteriological analysis of urine" M.; 2014. (in Russ.)

6. RF patent №2452773 "Method for determining the bacteriological contamination of urine, prostate secretion, ejaculate" (Bull. No. 16, 2012). Authors: Naboka Y.L., Kogan M.I., Gudima I.A. et al. (in Russ.)

7. Industry Standard "Patient Management Protocol. Intestinal dysbiosis "( ОСТ 91500.11.0004-2003). - M., 2003. (in Russ.)

8. Vyalkova AA, Gritsenko VA. Current aspects of the etiological diagnosis and treatment. Rossiyskiy Vestnik Perinatologii

9. I Pediatrii (Russiam Bulletin of Peri-natology and Pediatrics). 2017;62(1):99-108. (In Russ.) DOI: 10.21508 / 1027-40652017-62-1-99-108.

10. Nielsen KL, Stegger M, Kiil K, Godfrey PA, Feldgarden M, Lilje B, Andersen PS, Frimodt-M0ller N. Whole-genome comparison of urinary pathogenic Escherichia coli and faecal isolates of UTI pati ents and healthy controls. Int J Med Microbiol. 2017;307(8):497-507. DOI: 10.1016/j.ijmm.2017.09.007

11. Hsu CR, Pan YJ, Liu JY, Chen CT, Lin TL, Wang JT. Klebsiella pneumoniae translocates across the intestinal epithelium via Rho GTPase- and phosphatidylinositol 3-kinase/Akt-de-pendent cell invasion. Infect Immun. 2015;83(2):769-779. DOI: 10.1128/IAI.02345-14

12. Poole NM, Green SI, Rajan A, Vela LE, Zeng XL, Estes MK, Maresso AW. Role for FimH in Extraintestinal Pathogenic Escherichia coli Invasion and Translocation through the Intestinal Epithelium. Infect Immun. 2017;85(11):e00581-17. DOI: 10.1128/IAI.00581-17