title: The female urinary microbiome in urgency urinary incontinence.
abstract: OBJECTIVE
  The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes.
  
  
  METHODS
  Catheterized urine samples were collected from multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms.
  
  
  RESULTS
  More than one-half (51.1%; 93/182) of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m(2); P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P < .0001), responded better to treatment (decrease in urgency urinary incontinence episodes, -4.4 vs -3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%).
  
  
  CONCLUSIONS
  DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk.
authors.affiliation: Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Pearce
authors.affiliation: Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zilliox
authors.affiliation: Microbiology and Immunology Department, Hammer Health Sciences, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Rosenfeld
authors.affiliation: Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Krystal J
authors.initials: KJ
authors.lastname: Thomas-White
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.affiliation: Department of Reproductive Medicine, UC San Diego Health System, San Diego, CA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Nager
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Visco
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Nygaard
authors.affiliation: Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schaffer
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Moalli
authors.affiliation: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Sung
authors.affiliation: Department of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Ariana L
authors.initials: AL
authors.lastname: Smith
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rogers
authors.affiliation: RTI International, Research Triangle Park, NC.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Nolen
authors.affiliation: RTI International, Research Triangle Park, NC.
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
authors.affiliation: Contraception and Reproductive Health Branch, Center for Population Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Meikle
authors.affiliation: Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Gai
authors.affiliation: Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wolfe
authors.affiliation: Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL. Electronic address: lbrubaker@luc.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D001437:Bacteriuria / Q000453:epidemiology / Q000382:microbiology*; D016866:Bacteroidaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D015992:Body Mass Index; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005260:Female; D016975:Gardnerella / Q000235:genetics / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007778:Lactobacillus / Q000235:genetics / Q000302:isolation & purification; D064307:Microbiota / Q000235:genetics*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D018720:Prevotella / Q000235:genetics / Q000302:isolation & purification; D011788:Quality of Life; D012336:RNA, Ribosomal, 16S / Q000032:analysis*; D016896:Treatment Outcome; D053202:Urinary Incontinence, Urge / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D014551:Urinary Tract / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology
chemical_list: D065087:Acetylcholine Release Inhibitors; D018680:Cholinergic Antagonists; D012336:RNA, Ribosomal, 16S; D019274:Botulinum Toxins, Type A
keywords: bacteria; microbiome; microbiota; urgency urinary incontinence; urinary tract infection