SUFU 2018: Understanding the Pathogens Responsible for Recurrent Urinary Tract Infections in Postmenopausal Women

Austin, TX ( The work with murine models has shown that uropathogenic Escherichia coli (UPEC) is able to invade the bladder urothelium and form intracellular reservoirs. Dr. Nicole De Nisco and colleagues analyzed a cohort of postmenopausal women undergoing cystoscopy with fulguration of trigonitis (CFT) for treatment of RUTI after multiple failed antibiotic courses. 

They had bladder biopsies and urine from women meeting study criteria for antibiotic-refractory RUTIs and with office-based evidence of chronic cystitis on flexible cystoscopy. All samples were obtained in the operating room under anesthesia following a rigorous protocol. Antibiotics were discontinued for at least one week prior to CFT. Tissue and urine samples were analyzed using both culture-based and molecular approaches to determine if intracellular bacterial reservoirs are present within the bladder urothelium. The methods included aseptic microbial culture, 16S rRNA fluorescence in situ hybridization, 16S rRNA variable (v4) region Illumina deep sequencing, as well as basic molecular biology and histological techniques. 

They showed these preliminary studies of six post-menopausal RUTI patients with extensive cystitis cystica or pancystitis indicated that a variety of Gram-negative and Gram-positive bacteria were present inside the bladder urothelium. Strikingly, negative urine cultures at the time of CFT were noted in some patients despite positive bacterial tissue sample findings. 

In conclusion, they have found that diverse and unexpected bacterial species can invade the urothelium of severely infected post-menopausal RUTI patients. These intracellular bacterial reservoirs may explain the observed cycles of recurrence.

Presented by: Nicole De Nisco BS, PhD

Authors: Nicole De Nisco BS, PhD¹, Luming Chen BS², Marcela de Souza Santos PhD², Kelli Palmer PhD³, Kim Orth BS, MS, PhD² and Philippe Zimmern MD²

Author Information: 
1. UT Southwestern Medical Center and Howard Hughes Medical Institute; 
2. UT Southwestern Medical Center
3. UTD

Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas