膀胱驻留细菌与抗生素钙化性尿路感染妇女电膀胱术后复发风险增加有关

Jashkaran G. Gadhvi, Parker R.M. Kenee, Kevin C. Lutz, Fatima Khan, Qiwei Li, Philippe E. Zimmern, Nicole J. De Nisco
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引用次数: 0

摘要

背景。在绝经后妇女中,越来越多地观察到抗生素复发性尿路感染(rUTI)。因此,当标准抗生素疗法无效时,一些妇女会选择在诊室膀胱镜检查时对慢性膀胱炎区域进行电灌洗(EF)。EF 被认为可以清除之前在患有急性膀胱炎的绝经后妇女的膀胱壁上检测到的组织驻留细菌。我们假设,膀胱细菌负担的增加可能与 EF 后 rUTI 未完全消退有关。方法。在获得 IRB 批准后,我们从 34 名更年期女性中获得了膀胱活检样本,她们均同意选择 EF 作为 rUTI 的晚期治疗方法。使用通用探针和埃希氏探针进行 16S rRNA FISH 检测,并对组织中的细菌量进行量化。在为期 6 个月的随访期间,记录了 EF 后 UTI 复发的时间,并评估了膀胱细菌负荷和临床协变量与 UTI 复发的关系。结果。我们在 52% 的参与者和 92% 近期感染过大肠埃希氏菌尿毒症的参与者中观察到了膀胱驻留埃希氏菌。对复发时间的分析表明,通过通用探针检测到膀胱细菌负荷较高的女性在 EF 后六个月内患尿毒症的风险明显较高(P=0.035)(HR=3.15,95% CI:1.09-9.11)。有趣的是,膀胱驻留埃希氏菌与 UTI 复发风险较高并无明显关联(P=0.26)(HR=2.14,95% CI:0.58-7.90)。结论我们观察到,膀胱细菌总负荷与六个月内尿路感染复发风险增加 3.1 倍有关。继续分析膀胱细菌负荷与 rUTI 结果之间的关系可为管理这些具有挑战性的患者提供启示。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bladder-resident bacteria associated with increased risk of recurrence after electrofulguration in women with antibiotic-recalcitrant urinary tract infection
Background. Antibiotic-recalcitrant recurrent urinary tract infection (rUTI) is has become increasingly observed in postmenopausal women. Therefore, when standard antibiotic therapies have failed, some elect electrofulguration (EF) of areas of chronic cystitis when detected on office cystoscopy. EF is thought to remove tissue-resident bacteria that have been previously detected in the bladder walls of postmenopausal women with rUTI. We hypothesized that increased bladder bacterial burden may be associated with incomplete rUTI resolution following EF. Methods. Following IRB approval, bladder biopsies were obtained from 34 consenting menopausal women electing EF for the advanced management of rUTI. 16S rRNA FISH was performed using both universal and Escherichia probes and tissue-resident bacterial load was quantified. Time to UTI relapse after EF was recorded during a six-month follow-up period and the association of bladder bacterial burden and clinical covariates with UTI relapse was assessed. Results. We observed bladder-resident Escherichia in 52% of all participants and in 92% of participants with recent E. coli UTI. Time-to-relapse analysis revealed that women with high bladder bacterial burden as detected by the universal probe had a significantly (p=0.035) higher risk of UTI within six months of EF (HR=3.15, 95% CI: 1.09-9.11). Interestingly, bladder-resident Escherichia was not significantly associated (p=0.26) with a higher risk of UTI relapse (HR= 2.14, 95% CI: 0.58-7.90). Conclusions. We observed that total bladder bacterial burden was associated with a 3.1x increased risk of rUTI relapse within six months. Continued analysis of the relationship between bladder bacterial burden and rUTI outcomes may provide insight into the management of these challenging patients.
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