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The New World of the Urinary Microbiome in Women Journal Article
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| Authors: | Brubaker, L; Wolfe, A. J. |
| Article Title: | The New World of the Urinary Microbiome in Women |
| Abstract: | Emerging evidence challenges the long-held paradigm that the healthy bladder is sterile. These discoveries may provide new opportunities to address important women's health conditions, including pre-term labor and delivery, urinary tract infections and common forms of urinary incontinence. Traditional tools for urinary bacterial assessment, including urinary dipsticks and standard urine cultures, have significant limitations that restrict the information available to clinicians. For example, the standard urine culture does not detect slow growing bacteria that die in the presence of oxygen. Two new, complementary tools, however, can detect these and other organisms, permitting a more complete characterization of bacterial communities within the female bladder. Obstetrician-gynecologists should become familiar with these new approaches (expanded quantitative urine culture and 16S rRNA gene sequencing), which can detect previously unrecognized organisms. These advances are making it possible to answer previously intractable scientific and clinical questions. Traditional nomenclature used to describe the bacterial status in the bladder is quite dated and unsuited for the emerging information about the bacterial milieu of the female urinary tract. In the context of the sterile bladder paradigm, clinicians have learned about uropathogens, asymptomatic bacteriuria, and urinary tract infection. Given that the lower urinary tract is not sterile, these terms should be re-evaluated. Clinicians can already benefit from the emerging knowledge regarding urinary organisms that have previously gone undetected or unappreciated. For example, in some subpopulations of women with urinary symptoms, existing data suggests that the urinary bacterial community may be associated with women's health conditions of interest. This clinical opinion highlights the inadequacies of the current tools for urinary bacterial assessment, describes the new assessment tools, explains the current interpretation of the resulting data, and proposes potential clinical uses and relevance. A new world is opening to our view, giving us the opportunity to better understand urinary bacteria and the bladder in which they live. This new knowledge has significant potential to improve patient care in obstetrics and gynecology. |
| Journal Title: | American Journal of Obstetrics and Gynecology |
| ISSN: | 1097-6868; 0002-9378 |
| Publisher: | Elsevier Inc |
| Date Published: | 2015 |
| Language: | ENG |
| DOI/URL: |
S0002-9378(15)00508-6 |
| Notes: | LR: 20150525; CI: Copyright (c) 2015; JID: 0370476; OTO: NOTNLM; 2015/03/12 [received]; 2015/05/08 [revised]; 2015/05/17 [accepted]; aheadofprint |
