Urinary microbiome of people with spina bifida and UTI risk

An interesting new study abstract has been published looking in detail at the microbiomes (bacteria that naturally live) in the urinary and lower digestive systems of patients with spina bifida. It can be diagnostically challenging to tell the difference between someone who has a UTIs and someone who just has bacteria in the urine but no infection, this can lead to unnecessary antibiotic use. The research was presented at the Pediatric Urology Fall Congress in September 2024 at Louisville, Kentucky and key findings included: 

• Almost all the studied individuals with spina bifida had detectable bacteria in their urine. 
• The types of bacteria found in the urine of those with spina bifida tended to be more limited than would be seen in someone without the condition. Typically there would be large range of bacteria making up someone’s microbiome but the study showed that just one or two types tended to be dominant in those with spina bifida.  
• Escherichia and Shigella species were most prevalent in the urine and potentially contribute to recurrent UTIs. 
• Catheterisation increases the amount of bacteria from the skin found in bladder. This has implications for management because it suggests that finding bacteria such as S. aureus in the urine would not necessarily mean treatment was needed, especially in the absence of UTI symptoms.  

The study was conducted due to concerns of the impact of recurrent UTIs on the health of people with spina bifida over a lifetime and the potential risks of overprescribing of antibiotics on developing antibiotic resistant infections. The research is preliminary but with further investigation will hopefully help doctors to choose the most appropriate treatment.