NEW research provides valuable insights into the urinary and intestinal microbiomes of individuals with spina bifida (SB), a condition associated with an increased risk for urinary tract infections (UTI). Clinicians often face challenges in distinguishing between UTIs and asymptomatic bacteriuria in patients with SB, sometimes leading to unnecessary antibiotic use. This research aims to better understand these microbiomes and their role in UTI risk, potentially improving care and minimising overtreatment.
This prospective, single-centre study, conducted between October 2023–May 2024, included 60 individuals with SB, aged 0–30 years. Participants were recruited from an SB clinic and neonatal intensive care unit. The mean age of subjects was 7 years (range 0–20 years), with 57% male and 88% White. A significant 63% of participants had a history of UTI. The study focused on urine, stool, and skin samples collected during urodynamics. Expanded quantitative urine culture (EQUC) and 16S rRNA amplicon sequencing were performed on the specimens.
The team found that that 82% of urine samples showed bacterial growth on EQUC, much higher than the 60% typically seen in healthy children. Additionally, 97% of urine samples had detectable bacterial DNA through 16S sequencing, a rate significantly greater than the 84% seen in healthy paediatric controls. Among the detected bacteria, Escherichia-Shigella spp. were the most prevalent, found in 67% of urine samples and dominating in 50% of cases, suggesting that these bacteria are crucial contributors to UTI risk in patients with SB.
Furthermore, participants with a prior UTI history had a significantly higher abundance of Escherichia in their stool compared to those without UTI history (P<0.05), highlighting potential links between the intestinal and urinary microbiomes in UTI development. Those using clean intermittent catheterisation (CIC) had a higher abundance of Staphylococcus spp. in their urine compared to those not on CIC (P<0.05).
This research provides critical insights into the microbiological landscape of SB, pointing to Escherichia as a key player in UTI risk and highlighting the need for careful interpretation of bacterial presence in urine. The study paves the way for more tailored, effective management strategies for UTIs in the SB population.
Ada Enesco, EMJ
Reference
Frainey BT et al. Characterization of the urinary and intestinal microbiomes in individuals with spina bifida. Abstract 67. Pediatric Urology Fall Congress, 12-15 September, 2024.
