Urinary catheter-associated microbiota change in accordance with treatment and infection status. urogenital metagenome

The use of long-term catheterisation to manage insensate bladders, often associatedwith spinal cord injury (SCI), increases the risk of microbial colonisation and infection ofthe urinary tract. Urinary tract infection (UTI) is typically diagnosed and treated basedon the culturing of organisms from the urine, although this approach overlooks low titer,slow growing and non-traditional pathogens. Here, we present an investigation of theurinary tract microbiome in catheterised SCI individuals, using T-RFLP andmetagenomic sequencing of the microbial community. We monitored three neurogenicpatients over a period of 12 months, who were part of a larger study investigating theefficacy of probiotics in controlling UTIs, to determine how their urinary tract microbialcommunity composition changed over time and in relation to probiotic treatmentregimens. Bacterial biofilms adherent to urinary catheters were examined as a proxyfor bladder microbes. The microbial community composition of the urinary tract differedsignificantly between individuals. Probiotic therapy resulted in a significant change inthe microbial community associated with the catheters. The community also changedas a consequence of UTI and this shift in community composition preceded the clinicaldiagnosis of infection. Changes in the microbiota due to probiotic treatment or infectionwere transient, resolving to microbial communities similar to their pre-treatmentcommunities, suggesting that the native community was highly resilient. Based onthese results, we propose that monitoring a patient's microbial community can be usedto track the health of chronically catheterized patients and thus, can be used as part ofa health-status monitoring program.