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Rotjanapan P, Jaroensukrungruang A, Pisitkun P, Ngamjanyaporn P, Manonai J, Sawaswong V, Chanchaem P, Payungporn S. Vaginal microbiota affects urinary tract infection risk in women with systemic lupus erythematosus: a pilot cross-sectional study from Thailand. Lupus Sci Med 2021; 8:8/1/e000551. [PMID: 34706864 PMCID: PMC8552173 DOI: 10.1136/lupus-2021-000551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The risk factors associated with urinary tract infections (UTIs) in patients with SLE remain uncertain. We evaluated the vaginal microbiota pattern and its potential UTI-associated risk factors. METHODS A pilot cross-sectional study of patients with SLE was conducted at Ramathibodi Hospital, Bangkok, Thailand, during 2019-2020. Patients' demographic data and relevant information were collected. Vaginal microbiota was assessed in all patients and in 10 healthy volunteers. RESULTS Fifty-two patients were enrolled (mean age: 46.1 years). All patients had SLE that was in low disease activity. As per the Simpson_e index, the within-group alpha diversity of the vaginal microbiota was low in the SLE with UTI and SLE receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis groups. Multivariate logistic regression analysis revealed that TMP-SMX prophylaxis (adjusted OR (AOR), 30.96; 95% CI 3.63 to 264.11; p=0.002), elevated C3 levels (AOR, 35.33; 95% CI 1.33 to 936.67; p=0.033) and presence of Veillonella dispar in the vaginal microbiota (AOR, 6.68; 95% CI 1.27 to 35.07; p=0.025) were associated with UTI. CONCLUSIONS The vaginal microbiota diversity differed between patients with lupus with and without UTI, and unnecessary administration of TMP-SMX prophylaxis may affect the alpha diversity of the vaginal microbiota.
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Affiliation(s)
- Porpon Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aunyakant Jaroensukrungruang
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapaporn Pisitkun
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pintip Ngamjanyaporn
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jittima Manonai
- Division of Reproductive Health and Family Planning, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vorthon Sawaswong
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, Thailand.,Research Unit of Systems Microbiology, Department of Biochemistry, Chulalongkorn University, Bangkok, Thailand
| | - Prangwalai Chanchaem
- Research Unit of Systems Microbiology, Department of Biochemistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Systems Biology (CUSB), Chulalongkorn University, Bangkok, Thailand
| | - Sunchai Payungporn
- Research Unit of Systems Microbiology, Department of Biochemistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Systems Biology (CUSB), Chulalongkorn University, Bangkok, Thailand
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O’Brien VP, Gilbert NM, Lebratti T, Agarwal K, Foster L, Shin H, Lewis AL. Low-dose inoculation of Escherichia coli achieves robust vaginal colonization and results in ascending infection accompanied by severe uterine inflammation in mice. PLoS One 2019; 14:e0219941. [PMID: 31329630 PMCID: PMC6645506 DOI: 10.1371/journal.pone.0219941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/03/2019] [Indexed: 11/19/2022] Open
Abstract
Escherichia coli infection of the female reproductive tract is a significant cause of disease in humans and animals, but simple animal models are lacking. Here we report that vaginal inoculation of uropathogenic E. coli strains UTI89 and CFT073 in non-pregnant, estrogen-treated mice resulted in robust colonization of the vagina and uterine horns, whereas titers of the lab strain MG1655 were significantly lower. Non-estrogenized mice also became colonized, but there was more variation in titers. A dose of 104 colony-forming units (CFU) UTI89 was sufficient to result in colonization in all estrogenized mice, and we also observed bacterial transfer between inoculated and uninoculated estrogenized cage mates. UTI89 infection led to inflammation and leukocyte infiltration into the uterine horns as evidenced by tissue histology. Flow cytometry experiments revealed that neutrophil, monocyte and eosinophil populations were significantly increased in infected uterine horns. This model is a simple way to study host-pathogen interactions in E. coli vaginal colonization and uterine infection. There are immediate implications for investigators studying urinary tract infection using mouse models, as few E. coli are required to achieve reproductive colonization, resulting in an additional, underappreciated mucosal reservoir.
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Affiliation(s)
- Valerie P. O’Brien
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States of America
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Nicole M. Gilbert
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, United States of America
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Tania Lebratti
- Department of Medicine and Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Kavita Agarwal
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States of America
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Lynne Foster
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States of America
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Haina Shin
- Department of Medicine and Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Amanda L. Lewis
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States of America
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, United States of America
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
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Brandström P, Hansson S. Long-term, low-dose prophylaxis against urinary tract infections in young children. Pediatr Nephrol 2015; 30:425-32. [PMID: 24906665 DOI: 10.1007/s00467-014-2854-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 11/25/2022]
Abstract
Urinary tract infection (UTI) affects about 2 % of boys and 8 % of girls during the first 6 years of life with Escherichia coli as the predominant pathogen. Symptomatic UTI causes discomfort and distress, and carries a risk of inducing renal damage. The strong correlation between febrile UTI, dilating vesicoureteral reflux (VUR), and renal scarring led to the introduction of antibiotic prophylaxis for children with VUR to reduce the rate of UTI recurrence. It became common practice to use prophylaxis for children with VUR and other urinary tract abnormalities. This policy has been challenged because of a lack of scientific support. Now, randomized controlled studies are available that compare prophylaxis to no treatment or placebo. They show that children with normal urinary tracts or non-dilating VUR do not benefit from prophylaxis. Dilating VUR may still be an indication for prophylaxis in young children. After the first year of life, boys have very few recurrences and do not benefit from prophylaxis. Girls with dilating VUR, on the other hand, are more prone to recurrences and benefit from prophylaxis. There has been a decline in the use of prophylaxis due to questioning of its efficacy, increasing bacterial resistance, and a propensity to low adherence to medication. Alternative measures to reduce UTI recurrences should be emphasized. However, in selected patients carefully followed, prophylaxis can protect from recurrent UTI and long-term sequelae. 1. There is a strong correlation between UTI, VUR, and renal scarring. 2. Children with normal urinary tracts or non-dilating VUR do not benefit from prophylaxis. 3. Young children, mainly girls, with dilating VUR are at risk of recurrent UTI and acquired renal scarring and seem to gain from antibiotic prophylaxis. 4. Increasing bacterial resistance and low adherence with prescribed medication is a major obstacle to successful antibiotic prophylaxis.
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Affiliation(s)
- Per Brandström
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Rondvägen 10, 416 85, Göteborg, Sweden
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Robinson CJ, Bohannan BJM, Young VB. From structure to function: the ecology of host-associated microbial communities. Microbiol Mol Biol Rev 2010; 74:453-76. [PMID: 20805407 PMCID: PMC2937523 DOI: 10.1128/mmbr.00014-10] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In the past several years, we have witnessed an increased interest in understanding the structure and function of the indigenous microbiota that inhabits the human body. It is hoped that this will yield novel insight into the role of these complex microbial communities in human health and disease. What is less appreciated is that this recent activity owes a great deal to the pioneering efforts of microbial ecologists who have been studying communities in non-host-associated environments. Interactions between environmental microbiologists and human microbiota researchers have already contributed to advances in our understanding of the human microbiome. We review the work that has led to these recent advances and illustrate some of the possible future directions for continued collaboration between these groups of researchers. We discuss how the application of ecological theory to the human-associated microbiota can lead us past descriptions of community structure and toward an understanding of the functions of the human microbiota. Such an approach may lead to a shift in the prevention and treatment of human diseases that involves conservation or restoration of the normal community structure and function of the host-associated microbiota.
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Affiliation(s)
- Courtney J. Robinson
- Department of Internal Medicine, Division of Infectious Diseases, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, Center for Ecology and Evolutionary Biology, University of Oregon, Eugene, Oregon 97403
| | - Brendan J. M. Bohannan
- Department of Internal Medicine, Division of Infectious Diseases, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, Center for Ecology and Evolutionary Biology, University of Oregon, Eugene, Oregon 97403
| | - Vincent B. Young
- Department of Internal Medicine, Division of Infectious Diseases, Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, Center for Ecology and Evolutionary Biology, University of Oregon, Eugene, Oregon 97403
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Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections in women, and one in four of these women will develop a recurrence. Various risk factors predispose women of different age groups to recurrence. These factors include sexual intercourse, use of contraception, antimicrobials, oestrogen, genetics, and the distance of the urethra from the anus. Of the different pathogens, Escherichia coli is the organism most commonly isolated. A variety of treatment options has been proposed, including long-term or post-intercourse prophylaxis and patient-initiated therapy. Oestrogen and cranberry juice have also been used as prophylactic treatment adjuncts. At present, other therapeutic and preventive modalities are being investigated, including the development of vaccines to treat those most severely affected.
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Affiliation(s)
- Anna Virginia M Franco
- Department of Urogynaecology and Pelvic Reconstruction, 4th Floor Lanesborough Wing, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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Finer G, Landau D. Pathogenesis of urinary tract infections with normal female anatomy. THE LANCET. INFECTIOUS DISEASES 2004; 4:631-5. [PMID: 15451491 DOI: 10.1016/s1473-3099(04)01147-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recurrent urinary tract infections (UTIs) are common among girls and young women who are healthy and have anatomically normal urinary tracts. These infections are a main source of morbidity and health-care costs in this population. The interaction between specific infecting bacteria and urinary tract epithelium characteristics underlies the pathogenesis of this disease. Several pathogen-related factors predispose people to recurrent UTI, including periurethral bacterial colonisation and Escherichia coli virulence. Host behavioural risk factors include voiding dysfunction, high intercourse frequency, and oral contraceptive and spermicide use. The role of vesicoureteral reflux in recurrent childhood UTI is probably overestimated in the medical literature and is important only in a small group of children with high-grade reflux. Family pedigree analysis suggests a familial genetic predisposition for UTI among young females. Animal models show the multigenic nature of recurrent UTI. Putative candidate genes for the disease include ABH blood groups, interleukin-8 receptor (CXCR1), the human leucocyte antigen locus, toll-like receptors, tumour necrosis factor, and Tamm-Horsfall protein.
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Affiliation(s)
- Gal Finer
- Department of Paediatrics, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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