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Gram‑Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract
Kline, Kimberly A.; Lewis, Amanda L.
2016
Kline, K. A., & Lewis, A. L. (2016). Gram‑Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract. Microbiology Spectrum, 4(2). https://hdl.handle.net/10356/85576 https://doi.org/10.1128/microbiolspec.UTI‑0012‑2012
© 2016 American Society for Microbiology (ASM). This is the author created version of a work that has been peer reviewed and accepted for publication by Microbiology Spectrum, American Society for Microbiology (ASM). It incorporates referee’s comments but changes resulting from the publishing process, such as copyediting, structural formatting, may not be reflected in this document. The published version is available at: [http://dx.doi.org/10.1128/microbiolspec.UTI‑0012‑2012].
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ytes were present in in present were ytes 23 associated bacteria are la are bacteria associated 9
c - 20 r o k ] and there is no good good is no and there ] 15 mice; h mice; wing urinary catheterization [ catheterization urinary wing e comparat o at 1×10 wed that at 7 days post infection, both bladders bladders both post infection, 7 days wed that at v i o f ere complications ere els, leu els, mimic the conditions of patients with indwelling with indwelling patients of the conditions mimic ust infection in the cathete the in ust infection v ]. Cathete ]. v ]. While the well the While ].
xample, enterococci are rarely associated with with associated are rarely enterococci xample, wed similar kidn wed similar e e b e o 13 16 icantly higher CFU in the kidn the in CFU higher icantly ed in C3H/HeN mice mice in C3H/HeN ed as transurethrally inoculated into 7 into inoculated as transurethrally f gely from the patient’s the patient’s from gely ailable in PMC 2016 June 01. , preferentially infects the kidn the infects preferentially v ositive UTI ositive r or v biliary stents [ stents biliary
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y y Gram y y – e A 30 e d , actors contri actors f UTI is greate UTI is wl Author manuscript; complication of indwelling urinary catheters [ catheters urinary of indwelling complication 29
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v ]. Similarl ]. E. acquired UTI UTI acquired e - olume to consistently establish infection [ infection establish to consistently olume yticus 25 v ys were colonized at similar l similar at colonized were ys h associated UTI ( UTI associated ys, and on the catheter material itself where it forms a bio forms it itself where material on the catheter ys, and e - e r xperienced FGM were at 3 were FGM xperienced
e Microbiol Spectr ilm state and are thus recalcitrant to antibiotic treatment [ treatment to antibiotic recalcitrant and thus state are ilm e been d been e ]. f saprop v
a 12 infection [ infection D Sprague Harlan inoculum C with associated commonly h [ catheters urinary course the throughout remains it where inoculation, bacterial to prior bladder murine into the of infection. the kidn adapted from those used to study UTI caused by Gram caused UTI to study used those from adapted of 1.5 ml with inoculation WIS albino female of bladders and kidn [ noted damage and epithelial inflammation bladder S. sh mice female C3H/HeN [ infection post days 14 and 2, 7, and post infection 6 hours at bladder kidn in the persistence host that indicating sh GBS infection conditions, the same bio to s lead can infections these untreated, [ death and urosepsis, bacteremia, non of majority cause the C with associated community on sur the communities polymicrobial from isolated pathogens predominant the among and urinary catheters of indwelling by Gram infection and study to recapitulate systems Model [ Cathete common the most der to be thought are bacteria in 3 occurs Bacteriuria [ asymptomatic often is bacteriuria associated C pathogenic between ( urine in the neutrophils C of indicator diagnostic good cutting (FGM). A recent meta recent A (FGM). cutting had y models models to stu y r wis e Laborato Catheter associated UTI associated Catheter Kline and L
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o o ]. By analogy to mi to analogy By ]. r v p 32 Proteus mirabilis i viduals with indwelling urinary urinary with indwelling viduals ov w
infection studies infection i community in C in community ]. Co ]. 45 - Pseudomonas aeruuginosa or Streptococcus – mirabilis
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]. Aged multiparous anim multiparous Aged ]. f wed that e f xt of GBS, demonstrating ~1000 demonstrating of GBS, xt dr anisms [ anisms elopment of elopment o e - 39 g v r r ed microbial ed microbial and e
aecalis x f saprop ]. More ]. ators h ators o o xamine the epidemiolog xamine
g e w 38 obial UTI obial gizes with UPEC in the murine urinary tract, such tract, urinary murine the in UPEC with gizes esti r r v mirabilis n ust cathete ailable in PMC 2016 June 01.
occur in the urine of ind urine the occur in . v b - a P syne ys by UPEC [ by UPEC ys ylococcus , we will will , we ymic e r l h eral i icantly more often when the t the when often more icantly v f e also also erity of sequelae. of erity , immune compromised, and those with indwelling cathet indwelling with those and compromised, , immune v y Stap anisms anisms e ace of ro ace or po or f g f r the urinary tract by UPEC and UPEC and by tract urinary the yticus, Enterococcus gy between these t these gy between h r e o v as inoculated alone [ alone as inoculated e rise to greater CFU for both both for CFU greater rise to e ]. Similar studies in mice sh mice in studies Similar ]. i mirabilis
v w ilms that arise in catheterized ind catheterized that arise in ilms . Author manuscript; at ays in in ays a f
37 . P g g , and diabetes. Polymicrobial UTI is less common among young s young among less common is UTI Polymicrobial , and diabetes. , w ilms are often polymicrobial in nature [ nature in polymicrobial are often ilms A sequence analysis of bacterial bio bacterial of analysis A sequence saprop e y f
]. ]. n c N and UPEC in a murine UTI model h UTI model murine a in and UPEC - 36 anisms commonly co commonly anisms e bio 33 , g ]. Microscopic and microbial culture culture microbial and Microscopic ]. v r yelonephritis signi yelonephritis infection resulted in a more rapid d rapid a more in resulted infection i p - 20 incidence of urinary stones (urolithiasis) and bacteremia in a murine model of of in model a murine bacteremia and (urolithiasis) stones of urinary incidence 40 xt section of this chapte xt section omen. Since the highly polymicrobial microbiota of the GI and reproduct GI and the of microbiota polymicrobial highly the Since omen. co UTI bio e infection infection
- e Gram e posit w A - ylococcus v i e presence of multiple recognized uropathogens in midstream urine at titers >100,000 urine titers at midstream in uropathogens recognized of multiple presence h , malignan Microbiol Spectr
ed microbial inoculation into the urinary tracts of model o of model tracts urinary into the inoculation ed microbial v y these o y these i V x o species [ o species fects in ascending UTI, the nature of the ofmi the nature UTI, the ascending fects in h f atheters [ atheters aecalis w independent D independent that C e or s spectrum the influence n In the Gram isolated frequently most the to response and host Stap ascending UTI compared to monomicrobial infection [ infection to monomicrobial UTI compared ascending w c f species when each Streptococcus high titer persistent to susceptibility host and alter host immunity modulate GBS can kidn and bladder of the infection cont the in infection to UPEC prone particularly age to compared of GBS presence the in infection UPEC titer higher [ controls mi of inoculation transurethral ascending syne a suggesting infection, species to single compared together t that co of complementar use The infection. species single either path metabolism syne promote and thus posit increased continue to be useful in the search for antimicrobial agents aimed prat aimed agents antimicrobial for search the in useful be to continue Gram The occur infections Polymicrobial UTI. of etiology polymicrobial consistent with a is CFU/ml elderl the often among most HI act truly and since UTI, to leading source inoculation be a major to are thought s arise, UTI do polymicrobial persistent infection in the in infection persistent the e test to used been recently has model murine wis e Epidemiology and animal models models animal and Epidemiology Kline and L
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54 i ]. S. er the entire sur entire the er ]. It is thought that It thought ]. is – at ery rare (3 of 9314 urine samples were samples urine 9314 (3 of rare ery S. ) microbiota. H ) microbiota. 61 ov yticus g v Author manuscript; 52 52 ,
h yticus yticus e ylococcus . ed, male UTI caused by UTI caused male ed, omen [ omen omen are colonized with with colonized are omen , GI h h v saprop as is carried on the stap on the is carried 58 w
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all [ all f en time [ time en 60 mecA , antibiotic resistance resistance , antibiotic S. v ed among all among ed , r ection caused caused ection i yticus yticus e properties, binds to to binds properties, e v ]. ]. e f h h v v UTI virulence facto UTI virulence i 59 ylococcus S. sap S. e y g 66 h y coagulase n y coagulase obiocin resistance is a laboratory hallmark for identi for hallmark a laboratory is resistance obiocin Microbiol Spectr 25 year old old 25 year e been lin been e n , anism adhering adhering anism n v w – v g xual intercourse is also a risk risk a is also xual intercourse act xually o o a r astrointestinal ( astrointestinal yelonephritis [ yelonephritis ut has been ut has e e 65 electron micrographs of murine bladders infected with wild type type wild with infected bladders of murine micrographs electron o ind between junctions tight to the adherence h Conser adhes kidn rat of in colonization of >90% in is found Ssp, lipase, kidn persistent well as as UTI for acute is important and appendages, N H ma occur in penicillin of a [ ( element genetic mobile most As the Scanning cause infection. to necessary determinants virulence to respect with studied UTI display an interesting seasonal an interesting UTI display and early conditions, of complicating absence b a in UTI with presenting men older saprop obser is When it ind or institutionalized in spectrum to those caused by UTI [ p Stap of Colonies saprop 16 [ population this in UTI of uncomplicated cause s s a at g subsequent and colonization ract In yticus yticus h T
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79 80 yticus atty acids such as linoleic acid are acid are as linoleic acids such atty w and in GspB yticus to the to , serine that occur in the urine is the urine in that occur serine
, f ]. The presence of urease of presence The ]. 82 h h S. - strain vitro saprop
aureus 24 79 23 ]. ].
ibrinogen, and human bladder epithelial epithelial bladder human and ibrinogen, ys, for inflammation in the bladde the in for inflammation ys, in S. f e S. 92 ents binding to urothelial cells, perhaps via via perhaps cells, urothelial to binding ents alently attach a subset of secreted proteins proteins secreted of a subset attach alently ]. aureus adherence adherence saprop
saprop v
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e strains, is i strains, o h 78 xposure, in biological niches such as the the as such niches in biological xposure, S.
S. S. e associated sortase substrates compared to other other to substrates compared sortase associated
e accessory secretion secretion e accessory UafA, UafB, SdrI, and Sss SdrI, UafA, UafB, with bacterial sur bacterial with
v : ]. Uro ]. i all gulates the virulence determinant Ssp in the presence presence the Ssp in determinant virulence the gulates encoded UafB, found in ~5% of strains strains of in ~5% found encoded UafB, - e yticus saprop y infections [ y infections w ibronectin, ibronectin,
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yticus [ plasmids ferent ylococcus epidermidis e bacteria c e bacteria f ] h h v e cell i di 7108 [ 93 v saprop
i
o , the mechanism by which Ssp contri Ssp which by mechanism , the yticus ]. Plasmid ]. r mediates resistance to complement resistance mediates Stap w S. aspartate h e
posit - saprop 78 v -
]. e yticus S. and h w ace proteins also mediate adherence in adherence mediate also proteins ace 80 , on t , w putat f o yticus F e
saprop all associated proteins, proteins, associated all irst sequenced sequenced irst h
f serine deaminase mutants are outcompeted by the isogenic wild type type wild isogenic by the outcompeted are mutants deaminase serine Author manuscript; - w
ys in a murine model of UTI [ UTI of model a murine ys in S. ]. H ]. - . enting interactions of adhesin(s) with the cells [ cells with the of adhesin(s) interactions enting to tolerate high concentrations of D of high concentrations to tolerate ed among among ed e ery f v important prior to urethral urethral to prior important aureus saprop serine deaminase, found in in found deaminase, serine v
e v 76 - undant [ undant has been associated associated has been containing proteins predicted to be cell be cell to predicted proteins containing – - S. saprop b
74 S. yticus oding genetic locus in the sequenced strain is found on an SCC genetic element element genetic SCC on an found is strain sequenced in the locus genetic oding , attached sur attached associated serine associated h - understood. rich glycoprotein that binds binds that glycoprotein rich - xamined to date [ date to xamined - yticus - 24 e rich platelet binding proteins SraP in SraP proteins binding platelet rich e pathogens, these accessory Sec systems are associated with virulence [ virulence with are associated Sec systems accessory these pathogens, e h all ut does not promote bladder colonization in a murine UTI model [ UTI model murine a in colonization bladder promote notut does icient colonization of the bladder and kidn and bladder of the colonization icient all - ylococcus v f serine, and D and serine, ylococci. The ylococci. b i w f - h w Microbiol Spectr h well e been described in in described been e ] (Figure 1C). 1C). (Figure ] saprop v
a ut does not play a role in uropathogenesis in a murine model. Instead, SssF has been has SssF Instead, model. a murine in uropathogenesis a role in play not ut does 91 S. by D conferred [ of D kidn the strain in whose enc the to is similar arrangement genetic and whose of capsule [ neutrophils by human killing pr and masking Stap conser is highly b be to postulated polyunsaturated where area or periurethral perineum a particularly to cell In addition for e UTI [ of a rat model in spleen to the dissemination saprop strains strains a serine cells serine [ system secretion SecA2 accessory on an rely which putat for a gene contains that also locus posit cell associated is binds collagen, that strains, kidn persistent UTI and acute role in adhes the with homology structural Cell Cell Gram in enzymes Sortase signals, sorting or motifs, recognition sortase bearing signal sorting h possess strains stap [ UafA on its chromosome, substrate sortase Sss UafB and as well unsequenced cells epithelial bladder adhesion to that mediates model [ model not wis e Kline and L
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, xpressed and functional in functional and xpressed ]. A BLASTP search of the of the search A BLASTP ]. wer urinary tract tract wer urinary iv vitro w [ e is depleted, are both are depleted, is 94
o e 108 111 TCC 15305 [ 15305 TCC in gnant ind gnant 107 vi saprop mec
vities alone or in cooperation in cooperation or alone vities
A e ]. In murine UTI studies in the in UTI studies In murine ]. e , i
el el ABC S. k ]. In the mouse transurethral model model transurethral mouse the In ]. vity vity 115 106 inflammatory inflammatory i e been identi been e associated infections associated with with associated associated infections or -
- , v ealed the presence of 3 putat presence the ealed wth conditions promote bio promote wth conditions resistant and resistant a yticus PSMs are recruit, act recruit, - v o 116 bacteria into the murine murine into the bacteria h 50 h e o nic
, ilm coli 7 f
e infection [ infection e UTI [ w ] r ] v 49 T A i E. termed PSM termed mec xamined during UTI. during xamined 96 , yticus as [ e of properties forming
are usually encoded within the core genomes, genomes, core the within encoded are usually h saprop - v
, n that do not appear to be associated with MGEs MGEs with associated be to appear do not that isolates [ isolates
S.
ilm UTI in humans is not mar not is UTI humans in e antibacterial act antibacterial e ylococcal pro ylococcal core genomic PSM has been found that is instead is instead found that been PSM has genomic core
f e catheterized and pr and catheterized v - acquired infections where th where infections acquired polysaccharide is acting. polysaccharide aureus PSM ]. h y are able to to able y are in their peptide form, whereas PSMs that assemble assemble that whereas PSMs form, in their peptide - v
- a el and cobalt when zinc zinc when cobalt and el aureus i e e been been e saprop
k v S. able to colonize the bladder at a similar frequen similar a at bladder the colonize able to a S. yticus 106 S. ailable in PMC 2016 June 01. yticus h v is is a member of the human skin microbiota microbiota skin human of the is a member a h
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f which is a predominant cause of community acquired UTI, UTI, acquired of community cause predominant a which is S.
v v actors h actors i MG saprop e asion as th asion
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ation and are summarized in a recent r recent a in summarized are and ation e g S. S. xperimentally determined. xperimentally pathogenesis, inoculation of 10 of inoculation pathogenesis, aureus , ]. Ma ]. aureus xtracellular xtracellular e Author manuscript; virulence virulence
r ]. One One ]. e
e 80% identity to PSMβ1/2 80% identity . esti v – S. 99 saprop i S. e yuria, hematuria, and flank pain [ pain flank and hematuria, yuria,
v – ylococcal UTI ylococcal k p n at 105 S. e UTI and is characterized by symptoms such l as symptoms by is characterized UTI and e ] and are associated with 2.5% of C 2.5% with associated and are ] li h g – yticus unpublished). Whether Whether unpublished). are a lead cause of hospital are cause a lead ylococcal UTI ylococcal 96 - v
e e i e h i e been identi , aureus transporter that imports nic that imports transporter h v
icantly delayed kinetics, compared to to compared kinetics, delayed icantly v - i at f also also encodes an act 114 103 a S. g e UTI more often occurs in urinary often occurs UTI more utions of capsule of other uropathogens, such as UPEC [ UPEC as such uropathogens, other of capsule of utions n
ed in UTI colonization and virulence in a mouse model [ model a mouse in and virulence colonization UTI in ed b - saprop v
Microbiol Spectr ol S. aureus
v n yticus stap yticus resistant [ resistant of cathete absence with signi to response The immune Gram inflammation, of S. Opp5a) h third ABC i no other n Coagulase in bio especially pathogen, opportunistic important d medical indwelling of act area epidermidis sequenced genome of genome sequenced PSMβ1 to homologous 55 with peptides (K.A. Kline, be to UTI remains to In contrast aureus of The majority d subsequent with associated Phenol soluble modulins ( modulins soluble Phenol in characterized in immune crucial and are [ neutrophils [ niche a within microbes other kill can that peptides host antimicrobial with bio mediate PSMs also into amyloid [ stability SCC the with associated [ virulence and resistance methicillin human multiple including contri this UTI of stages at which to determine h op
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f S. h hemolytic
UTI 5:1 [ UTI 5:1 ]. These di These ]. icant medical problem, with problem, medical icant - 24
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], others report that that report others ], w - 126 ed, with ~100 ed, v , aecium saprop 125 kidn
f ]. Ent ].
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121 E. 118 w the host handles host w the E. 124 are also at increased risk for UTI [ for risk increased at also are o unit protein of the mitochondrial compl mitochondrial of the protein unit
b , all of which pea ofwhich , all 19 mice produce l produce 19 mice yelonephritis after after intr yelonephritis r - p e anaerobes are γ are e anaerobes , a role for the mitochondrial respiratory chain chain respiratory mitochondrial , a for the role y titers obser y titers PMC 2016 June 01. omen [ omen y v
e i diabetics [ diabetics viduals viduals - i ytokines and signi and ytokines w c bladde ococci alent among among alent e lactic acid bacteria that typically occur as occur that typically bacteria acid e lactic e for intracellular killing of killing intracellular e for innate inflammatory immune response to to response immune inflammatory innate r v v out of a su of out i etic etic i ev - induced (alloxan) diabetic rats and non rats and diabetic (alloxan) induced w outnumbers w outnumbers acultat ed in UTI described to date are also bio also date are to described UTI in ed ailable in - ], whereas whereas ], f ilms on abiotic sur on abiotic ilms o v v f a ]. Recentl ]. diab posit ol animal studies. In a chemically studies. In animal - ]. The The ]. - 127 v 24 fold more CFU from the from CFU more fold n y Ente y - 61 actor for prostatitis, for which enterococci are responsible for responsible are enterococci for which prostatitis, for actor UTI n , f due to of UTIs The incidence ].
b associated UTIs and are the third leading cause of hospital of cause leading third the are and UTIs associated ]. Diabetic ind Diabetic ]. - inflammatory inflammatory r innate immune response to response immune innate 49 - UTI[ elops bio elops
130
v irst mechanistic study of h study irst mechanistic 119 , act that do not form [ spores form do not that act actors i actors e f , f f y compared to the the to y compared aecalis e f
129 ery of 100 of ery yticus 115 E. are more often associated with UTI among diabetics and cause 13% of 13% and cause diabetics UTI among with often associated more are h Author manuscript;
,
ov . diabetic mice [ mice diabetic resistant enterococcal strains presents a signi presents strains enterococcal resistant 9.9, sodium chloride concentrations up to 6.5%, bile salts up to 40%, and and up to 40%, salts bile up to 6.5%, concentrations chloride 9.9, sodium - es as a nidus for the higher incidence of bacteremia in this population [ in this population of bacteremia incidence higher for the nidus a es as - 13 – are responsible for a minority of community of minority for a are responsible v similar in chemically similar ytokines and are defect and are ytokines
e been reflected in in reflected e been UTI reflected the higher kidn higher the UTI reflected in a murine model may reflect the propensity of this o this of propensity the reflect may model in a murine c 10 from ranges temperature including conditions vironmental spp.
v n as ) is prone to spontaneous urinary tract infection by infection tract urinary spontaneous to prone ) is a saprop infection, macrophages from GRIM from macrophages infection, drug
ococcal UTI ococcal w - omen compared to non to compared omen r
19
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]. Diabetes is also a risk a risk is also Diabetes ]. E. Microbiol Spectr ], which ser which ], frequen in the no increase studies indicate some While ]. aecalis ersity of e of ersity f iltrating in the kidn the in iltrating er the years and years er the GRIM
f v i yelonephritis in humans [ in humans yelonephritis ancomycin resistance increasingly pr increasingly resistance ancomycin 128 E. [ [ of cases up to 10% ov to multiple v d to and adheres readily virulence enterococcal and of cathete 30% 15 to cause [ UTIs acquired 121 123 diabetic Enterococcus in non 4.9% to compared diabetics ASB in h in humans to susceptible were more mice diabetic diabetes, of murine model non to compared inflammatory inflammatory this reflects report This infection. of Gram a genus are Enterococci These chains. or in short diplococci d 4.6 from ranges the despite desiccation saprop p saprop pro numerous of induction in to the bladder recruitment macrophage Enhanced infection. of stages in the implicated has been knock a heterogeneous strain carrying I ( to response resulted in the rec in the resulted [ post infection 2 weeks as long as for and infection post hours ract In T
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v bind 138 -
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e immunity and e immunity
c f e isolates [ isolates Ebp is k v suggesting that their their that suggesting
mutant is attenuated in is attenuated mutant i actors i actors w , 152 AS) motif in the in AS) motif f dia o o , ilm formation, and and formation, ilm - vitro D f and MI and v
i ebp ylated lipotechoic acid acid lipotechoic ylated -
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151 onization in a mouse model, model, a mouse in onization aecalis e , all proteins in addition to the the to addition in proteins all f actors function in a similar a similar in function actors in
f ala
gulatory system and, system gulatory w virulence in animal models models animal in virulence - 149 27 e ation substance [ substance ation E. o , g ace protein that is enriched among among is enriched that protein ace UTI, bio UTI, and aecium e f Streptococcus
mutans are signi are mutans f 30 A ibronectin binding protein EfbA [ EfbA protein binding ibronectin
) relies on a pilus on a ) relies e bacteria, biogenesis of the of the biogenesis e bacteria, f A domain v E. i W vitro ]. Furthermore, SrtA and the Ebp are are Ebp the SrtA and Furthermore, ].
amily transcription amily ahrC Ebp UTI [ UTI ute to ur ute to gA of gA terminus of EbpA, the li the of EbpA, terminus f G), and D G), and ution to infection in the absence of foreign offoreign absence in the infection to ution r - in ilm formation formation ilm b A ut not SrtA, are important for ascending important are SrtA, notut f b posit
148 ]. An ]. emporal analysis of analysis emporal b - component r component gR , DA ]. T actors monoglucosyl actors - r f ) proteins and human platelets platelets human and ) proteins o
]. The V The ]. ]. ]. 149 dependent C dependent w 144 137 - ge ~200kD sur ~200kD ge , r vitro, and and vitro, 155 147
during C [
– SrtA is important for the early attachment stage of attachment the early for is important SrtA ECM
all, including aggr including all,
in o utable to multiple cell cell to multiple utable (MI site adhesion dependent o aecalis 136 ]. The A The ]. ut its contri ut its - w f v [ ailable in PMC 2016 June 01. b v
i
i b v 144 pathogen interaction in the urinary tract [ tract urinary in the interaction pathogen ]. Esp promotes bladder col bladder promotes Esp ]. v a
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, E. 140 associated pilus ( pilus associated - in in 77 vitro 135
e domains, sharing sequence similarity with Rib and C alpha C alpha with and Rib similarity sequence sharing e domains, ]. Thus, it appears clear that clear appears it Thus, ]. – wed that v ylglycerol (DGlc ylglycerol ilm SrtC and the Ebp, Ebp, SrtC the and the cell cell the i in o f c
153 132 sh ace proteins that contri that proteins ace f A) domain within the N within the domain A) SrtC) for pilus polymerization and the house the and polymerization pilus SrtC) for dia
- assembled pili in Gram in pili assembled ilm formation ilm W - formation and infection in the absence of abiotic d of abiotic the absence in and infection formation , it is unclear whether these virulence virulence these whether unclear , it is f
r sur
aecalis s e vitro f
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v proteinacious proteinacious gulated by the GrvRS t the by gulated asion [ asion ace protein Esp is a la is Esp protein ace ilm ilm - e xtracellular matrix ( matrix xtracellular Author manuscript; e f mutants are attenuated for bio for attenuated are mutants f in
E. ilm formation formation ilm
e . predicted metal ion metal predicted ev aecalis, w f all anchoring [ anchoring all f o
sur w aecalis
wth on catheters as well as for bladder and kidn bladder and for as well as catheters wth on , a ilm formation formation ilm f dder colonization colonization dder E.
o f y gvrR ]. Non ]. actor A (V A actor f , E. as found to be essential for Ebp essential be to found as ution of SrtA may be attri may of SrtA ution y G), diglucosyl G), b w 141 ]. Ace is r Ace ]. endocarditis and bio and endocarditis aecalis ilm gr ilm
the absence of catheter in an outbred mouse model [ model mouse an outbred in of catheter absence the f
f DA ) for cell cell for ) 139 E. Microbiol Spectr ilm formation during infection, infection, formation during ilm ilm formation ilm [ Ebp and the is SrtC formation, as ilm ]. Recentl ]. , A) appear to limit UTI virulence because mutations in synthetic genes for each of these of these for each genes synthetic in mutations because UTI virulence limit to A) appear UTI [ UTI f f f vices may be species dependent. be species vices may illebrand illebrand T A e xpression interferes with the host the with interferes xpression SrtA L aecalis the ascending UTI model [ UTI model the ascending bio d bind can pili Ebp 154 W the Ebp, bla associated R pilin tip as the as well GBS, of PilA containing f C in (Sortase ( bio bio bio for important to proteins multiple attaches the contri In contrast, pilus. UTI in [ mice inbred UTI in for ascending required accordingl [ UTI ascending of model murine bio for early important for bio C (MGlc ( cells urothelial of colonization increase products e tosortase other Similar The fecal to compared isolates endocarditis and bloodstream enterococcal repetit multiple of composed protect which confer B streptococci, in group determinants virulence immune mediate bio as as well Additional the enterococcal Ace and adhesin collagen the include 138 determinants. H determinants. bio during manner UTI virulence facto virulence UTI wis e E. faecalis faecalis E. Kline and L
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169 e , e rise to dysuria, urinary dysuria, rise to e ]. More ]. suggesting lack of adherence of adherence lack suggesting v
166 i 24 y tropism is a common theme theme is a common y tropism – aecium ]. ], ]. Despite being commonly commonly being Despite ]. 15 f e binding oligimerization domain oligimerization binding
- y infection. Aggr y infection. , Gram 85 26 transiently transfected 293 cells transfected transiently e oiding, and the same same the and oiding, aecalis oxidation, not only promote promote only not oxidation, r ut also during ascending UTI ascending during ut also E. - 162 f v 172 e
b ]. A number of A number ]. , , wer urinary tract symptoms (LUTS) symptoms tract urinary wer – v r o e E. e receptor 2 receptor e e k v ]. Kidn ]. pathogenic o pathogenic w y 162 139 e - 170 li [ o h
- , w eolar and intestinal intestinal and eolar mediated immune in immune mediated 159 o - v [ A domain of the PilA tip pilin of GBS is GBS is of pilin tip PilA of the A domain 15
W erse protein protein erse ]. H ]. v aecalis f yuria. H yuria. e vitro
either in TLR2 either in p aecalis
macrophages may be important for the ability of ability for the important be may macrophages 168 f E.
in xperimental peritonitis [ peritonitis xperimental , edema [ edema e
E. xplanation w xplanation EbpA mediates binding to host host to binding EbpA mediates ]. The V The ]. 26
e al within human neutrophils [ neutrophils human within al ailable in PMC 2016 June 01. icient to clear the kidn the clear to icient aecalis v f iv f f a ] and it has been proposed that glycosaminoglycans on glycosaminoglycans that proposed been it has and ] 157 with urine storage and and storage urine with
e stress responses [ responses e stress , UTI is rarely symptomatic [ symptomatic rarely is UTI ertheless, urothelial cells containing intracellular intracellular containing cells urothelial ertheless, al within within al peptidoglycan fragments [ fragments peptidoglycan v E.
i v
A aecalis surv iv 161 e can colonize and persist in the kidn the in persist and can colonize f
al within macrophages, including including within macrophages, al inflammatory signaling cascades can also be induced via induced be also can cascades signaling inflammatory [ of mono primarily consisted post infection, days 2 ys at
156 - e iv as insu as delineated. In mice, toll In mice, delineated. E. . N r - w mediated signaling, and these are thought to be important for important be thought to are these and signaling, mediated aecalis - f lactis
aecalis
aecalis f
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o Author manuscript; UTI is accompanied by accompanied is UTI i iv
]. . ococcal UTI ococcal ed in the urine of patients displaying l displaying patients of urine in the ed A r v infected kidn infected AS motif of AS motif ed in TLR ed in ade human urothelial cells cells urothelial human ade in the bladde in the 158 D v
v ace, pr ace, n f ol Lactococcus UTI and where surv UTIwhere and
v n ) protein and protein ) UTI [ UTI ogether these studies present a picture in which macrophages are a are macrophages in which picture a present studies these ogether or in the murine urinary tract [ tract urinary murine or in the , urothelial damage, and bladder and bladder damage, , urothelial and and A y aecalis T ed in the the in ed ed in the host response to host response in the ed
e longer within macrophages compared to non to compared macrophages within e longer al within act within al The MI The f c
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gen v a a r xtracellular matrix proteins [ proteins matrix xtracellular 167 n signaling neutrophil recruitment during during recruitment neutrophil signaling upta nucleotide macrophage the intracellular between interaction 2 ( C UTI, ascending to In contrast g can infection, of bacterial absence in the alone, catherization u C asymptomatic, surv [ E. niche. this within persist to enterococci to leading cascades signaling The host well not yet is tract urinary to Gram responses innate immune initiate to lipopeptides recognizes i in protein adaptor intracellular the and TLR2 both requires macrophages peritoneal murine i MyD88 strains can i can strains posit Gram among obser and and neutrophils, cells promotes substance surv DH5α sur the macrophage h oxidat and Ace, polysaccharide, r to predicted B, A and reductases sulfoxide vitro coats the and subsequently implantation catheter to response in bladder the in released sur catheter with C model, In a murine [ inflammation of apparent absence in the the bladder from by h associated and issues pain as such e al human to adhesion for bacterial important also wis e une responses to ente une responses m Im Kline and L
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k CFU [ CFU r mediated inflammatory inflammatory mediated
- 6 r in a bio
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e v f - wn that a subset of strains were were of strains subset wn that a xtran Sulphate Sodium salt (DSS) salt Sodium Sulphate xtran o strains isolated from the from strains isolated UTI, mar
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r gnant, diabetic, and and diabetic, gnant, a wnr and macrophage inflammatory protein inflammatory macrophage and e
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e o although the presence of presence the although ilm on cathete the ilm n
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yuria than those caused by Gram caused those than yuria posit k ant guts h guts ant E. CFU during CFUC during - f p
in wn as group B as group wn 173 ogether these studies indicate that high titer high titer that indicate studies these ogether ytokine ytokine o ercome the ro the ercome ut also in pr in also ut yelonephritis that can progress to bacteremia and/or bacteremia to progress that can yelonephritis rization and subsequent signaling [ signaling subsequent rization and c T b p ailable in PMC 2016 June 01. oup B oup B ov , v ]. r receptor (TIR) domain containing protein ( protein containing domain (TIR) receptor y a ving the catheter implant together with with together implant catheter ving the aecalis i 1 f
- D a in responses ytokine eral studies of eral studies can 179 ]. In addition, there is a is there In addition, ].
c v y G y – E. e y human in y human e bacilli [ e bacilli b h v i 174 UTI isolates and can d can and UTI isolates forming coccus that is a common asymptomatic inhabitant of the of inhabitant asymptomatic common is a that coccus forming
[ UTI model where implantation of a foreign body (catheter) alone alone (catheter) body of a foreign implantation where model UTI 177 - viduals, as well as those with prewith those well as as viduals, ving catheter alone [ alone ving catheter
at otherwise kn otherwise i i measured by leu measured
A ement of GBS in as ma in as GBS of ement g aecalis , f e v inflammatory inflammatory
]. While GBS may represent only a small fraction of total UTIs, the UTIs, of total fraction small a only represent GBS may While ]. n ol - vitro , as inding, s inding, E. chain
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Author manuscript; among the elderl the among – oll/interleukin
fering responses of macrophage to of macrophage responses fering . 2% of all monomicrobial UTIs [ UTIs monomicrobial of all 2% f alactiae T E. 181 – ated macrophages during during macrophages ated g
1 ]. Despite high high Despite ]. UTI associated with Gram with UTI associated a 182 iv despite bacterial loads in the bladder bladder the loads in bacterial despite
histopathology including edema, urothelium damage, and proinflammatory proinflammatory and damage, urothelium edema, including histopathology w anw i ,
A fold increase of interleukin 1β of interleukin increase fold 31 o - UTI is not highly inflammatory and can be immunosuppress be can and inflammatory highly notUTI is 10 hemolytic xpression. xpression. A y [ - 1α), e e as well as suppressing as suppressing well as - results in a modest augmentation of inflammation in the bladde the in of inflammation augmentation in results a modest C
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f e β g v i Microbiol Spectr (Mip UTI is more strongly associated with with associated strongly is more UTI anisms. C anisms. iltrating act iltrating ferential inflammatory responses to enterococcal C enterococcal to responses inflammatory ferential vitro
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e for GBS rectal or rectal GBS e for ]. Other s Other ]. c gued that this study this study that gued v r ]. w i omen; as a result, some some as a result, omen; o ]. The Centers for Disease Disease for Centers The ]. at ], suggesting that the urinary that the suggesting ], w 200 g 188 gnan e of l omen during labor and del labor and during omen ,
e 192 201 w – ating whether l whether ating fold increased fold increased e rectal colonization at 35 at colonization rectal gnant gnant 187 - ], with approximately 160,000 cases 160,000 cases approximately with ], g - v e actor for maternal for maternal actor i wborns and can be acquired by the acquired be can and wborns 189
of these are cases of urosepsis [ urosepsis of are cases of these f e 30 10 , – esti v culture [ culture ut it has been a has been ut it n posit
aginal 187 ], it has been estimated that up to 7% of of 7% that up to estimated been it has ], - b v e an apparent focal origin such as cellulitis, cellulitis, as such origin focal an apparent e omen underwent urine culture [ culture urine underwent omen v e a 20 e a a w ]. In about 30% of cases, systemic infections infections systemic cases, of 30% In about ]. 180 v a omen who test n who test omen erse maternal or neonatal outcomes. One study One study outcomes. neonatal or maternal erse v w 186 , h inding, inding, 2% [ 2% viduals; 14% viduals; , y f i – er viduals with GBS urosepsis include diabetes mellitus, mellitus, diabetes include urosepsis GBS with viduals i v 185 i concentration of GBS detected in in detected of GBS concentration ailable in PMC 2016 June 01.
v w titer GBS bacteriuria were at higher risk of GBS of GBS risk at higher were bacteriuria GBS w titer y a o n a ylaxis for culture ylaxis e for GBS in urine GBS e for h v i y GBS colonies in urine cultures from all all from cultures urine in colonies y GBS
imated 1 at imated n icant titers of GBS in urine [ urine in GBS of titers icant f y disease, recurrent urinary tract infections, obstruct infections, urinary tract recurrent y disease, ].” e tract, GBS is often found to colonize the urinary tracts of tracts urinary the colonize to found is often GBS e tract, gnant adults do not h do not adults gnant e v ersal screening of GBS of GBS screening ersal e i v wth in urine of other pathogens at concentrations < 10 < concentrations at pathogens other of urine wth in irm or refute this this refute or irm i omen without detectable GBS in urine [ urine GBS in detectable without omen ]. The 2002 recommendations from the CDC stated that clinical that clinical the CDC stated from recommendations 2002 The ]. 199 f o omen with l with omen whether urine samples are from pr are from samples urine whether w e signi e
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v 198 w y Author manuscript; a
. o – or during passage through the colonized birth canal. In addition to to In addition canal. birth colonized the through passage or during orkload for clinical microbiology laboratories, which do not generally generally do not which laboratories, microbiology for clinical orkload c
e age [ e age w gnant adults, the incidence of systemic GBS infections is estimated at estimated is GBS infections systemic of incidence the adults, gnant v i e 193 , there is little published clinical data i clinical published is little , there utero , chronic kidn , chronic
y omen. Although GBS colonization of the urinary tract in pr tract urinary the of GBS colonization Although omen. omen h omen , and neurogenic bladder [ bladder neurogenic and , y y w w in c h omatic, GBS bacteriuria is an independent risk independent is an bacteriuria GBS omatic, , additional studies are required to estimate the threat the threat estimate to required are studies , additional gnant populations, est populations, gnant y e icantly [ icantly f “increased “increased gr bacterial report kn and rarely a for search laboratories reproduct CFU/ml) in urine is associated with ad with inis associated urine CFU/ml) Microbiol Spectr e been biased because only a subset of the of the a subset only because biased been e
gnant gnant gnant gnant 4 v wborn e e vised guidelines notes that this practice represents an represents practice that this notes guidelines vised a e yelonephritis, and antibiotic treatment of ASB has been demonstrated to reduce these risks risks these reduce to demonstrated been has ASB of treatment and antibiotic yelonephritis, aginal colonization test posit test colonization aginal urden of GBS UTI is a major public health concern [ concern health public major UTI is a GBS of urden e 10 of babies that found to disease compared con to been performed h Clearl prop and for screening of action course the best determine disease and GBS neonatal of 4% that study estimated One measures. v in be missed that could bacterium for the niche independent and distinct be could a tract p signi report should labs microbiology r Surprisingl GBS is the leading cause of sepsis and meningitis in n in meningitis and of sepsis cause leading GBS is the n reproduct the colonizing pr asympt [ GBS sepsis neonatal as as well chorioamnionitis un recommend Control prop antibiotic and of gestation pr in recommended also ASB is for treatment and Screening del preterm of risk higher at ASB are Among nonpr Among ind 100,000 per 4.4 cases approximately of ind conditions underlying Common malignan neuropat in nonpr by GBS caused in young GBS with associated UTIs of proportion the to In contrast UTI. or pneumonia, nonpr pr b U.S. the in annually wis e GBS bacteriuria in pregnan in GBS bacteriuria Kline and L
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209 n – gnan anism has not anism eral recent icant e icant e g ed di f v 1α), r elop an e elop e k - 202 e infection (4 infection e v and i and
disease in in at disease e v ely to be associated be associated to ely i l studies are needed l studies k xamined GBS GBS xamined as ylactic antibiotics at antibiotics ylactic e (MIP v h
e n e a signi e a ely little is kn little ely v v 1α v a ed a striking lack of lack striking a ed a i - ] and mar and ] e GBS infection are also also are infection e GBS ging, rare and/or and/or rare ging, v e formed the basis for for basis the formed e r v i v xt. 25 a e
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as gies are lacking in settings in lacking gies are v ]. Additiona ]. erity of GBS GBS of erity v e i n v actors to injure actors e f ants with i with ants e obser e f 213 v ]. A number of GBS virulence virulence of GBS number A ]. disproportionate number of acute of acute number disproportionate thus, relat thus, ystitis [ ystitis eral eme , the CDC recommends that recommends CDC , the a , w studies h w studies c y v e e microbe interactions in populations at populations in interactions microbe 25 211 - ylactic measures during pr during measures ylactic h ions using serotype III GBS strains in mouse mouse in strains GBS III serotype using ions ention strat ention ]. In the murine model, the presence of GBS GBS of presence the model, murine In the ]. v ariety of GBS serotypes are associated with with associated are serotypes GBS of ariety did not appear to h to not appear did UTI [ UTI e
y should be g be y should
e demonstrated that sialic acid residues of the of the residues acid sialic that e demonstrated v c v une responses 212 e GBS disease. Attempts to d Attempts disease. GBS e ut only a f only a ut a , v times more frequent than GBS neonatal infections infections neonatal GBS than frequent more times b atality rates for rates i atality coli i m
- f gnan as E. e 211 v ytolysin , n ailable in PMC 2016 June 01. c v ]. These clinical studies h studies clinical These ]. as found to cause a a cause to found as wn that a a 25 . Case o w xperimental studies h studies xperimental y 183 e ariety of body sites (skin, soft tissue, lung, peritoneum, peritoneum, lung, tissue, soft (skin, sites body of ariety , we will 1) discuss s 1) discuss will , we r , v
r e sh . e v y ], macrophage inflammatory protein inflammatory macrophage ], e pathogens of the urinary tract, 2) introduce s 2) introduce tract, urinary the of e pathogens v a actors of importance in the urinary tract and to understand the the understand to and tract urinary the in importance of actors
v y time in pr y time e f er i y n v hemolysin/ ]. These studies h studies These ]. l w i 212 - chapte [ o
wing transurethral infection [ infection wing transurethral wn about the molecular epidemiology of GBS, the o the GBS, of epidemiology the molecular wn about ely in animal models of UTI and and of UTI models animal in ely o
213 posit o - 1α v , ]. H ]. i - Author manuscript; , and biochemical details details of host biochemical , and
elderly (~15%) compared to young in young to compared (~15%) elderly r . 39 actors may play important roles in this cont this in roles play important may actors e been successful in early trials in animals and humans [ and humans in animals trials early in been successful e 25 f , v al foll al a , serotype III GBS GBS III serotype , , in contrast to screening and prop and screening to in contrast , xtens 25 r r iv e 10 [ 10 e e - v v actors by inoculating wild type and mutant strains of bacteria into the mouse mouse into the of bacteria strains mutant and type wild by inoculating actors characterized in other models, models, other in characterized e e f s and induction of host im of host induction s and r of labor and del and of labor ], whereas the β the whereas ], w w
, molecula o o elderly patients are at risk of i at risk are patients elderly accine h accine r 25 v partum periods, similar screening and pr and screening similar periods, partum - Microbiol Spectr e been been e ]. H ]. ustly induces IL induces ustly 9, and IL 9, and - v b a xperimental studies of GBS urinary tract infect urinary tract GBS of studies xperimental 10 urinary tract [ tract urinary urinary GBS in the of establishment for optimal are necessary polysaccharide GBS capsular [ tract surv bacterial virulence GBS to identify cellula disease. GBS risk for of this remainder In the Gram underreported UTI. H UTI. li more were which serotypes, other to disease compared symptomatic [ bacteriuria with asymptomatic e [ infection of transurethral models ro IL GBS during bladder in the inflammation histological to compared responses transcriptional h virulence groups. a at infections cause GBS can virulence of range a wide utilizes etc.) and tract, urinary [ meningitis) osteomyelitis, bacteremia, (e.g. infection in disseminated resulting tissues, kn is much Although been studied virulence which h analyses Epidemiological the time 10 approximately GBS is by UTI caused elderl the among and is common the among higher [ post where GBS s and incidence the in reductions future of the possibility routine third trimester screening procedures. Currentl procedures. screening trimester routine third a at bacteriuria GBS with wis e asive GBS disease in the elder disease in GBS asive v n GBS virulence facto GBS virulence I Kline and L
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ariety of ariety , V r v e bacteria) e bacteria) e v . As described i aginal aginal v aginal aginal microbiota y and UTI h UTI and e v aginal condition condition aginal
v omen omen [ indings, clinical clinical indings, v a single a single ], which is based based is which ], f astidious w
vidence vidence omen with omen f w o w in B w in e posit aginal microbiota microbiota aginal o w - e) v 220 vironment for vironment erse repertoire of repertoire erse aginal fluid, fluid, aginal gr v n v ]. H ]. v r i i aginal lactobacilli are at are lactobacilli aginal e ]. This This ]. v aginosis are more prone to prone more are aginosis ov 228 associated associated xamine xamine v - – 216 e fold increased risk of UTI of risk increased fold ydrogen peroxide, and other and peroxide, ydrogen ]. Clinical features of BV (i.e. (i.e. of BV features Clinical ]. - oman’s oman’s V – probiotic administration may may administration probiotic h ]. These studies are consistent are consistent studies These ]. wing that wing w
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v 217 - v ic mechanisms to discourage UTI UTI to discourage mechanisms ic agina [ agina ov i rs and a more d a more rs and xperimental models. While it remains a a remains it While models. xperimental f v e xclus e ]. Another method for BV diagnosi BV for method Another ]. xually xually act ]. Further supporting these these supporting Further ]. e Firmicutes stained slides where a higher score indicates indicates score higher a where stained slides 221 - – omen with bacterial bacterial omen with 216 y (s dominant population of population dominant – w h
indings raise the possibility that that possibility the raise indings 219
f y hanisms to enhance UTI susceptibilit to enhance hanisms h 214 Figure 2 (with emphasis on Gram emphasis 2 (with Figure xamining the association between BV between association the xamining e been described in the B in the described been e ailable in PMC 2016 June 01. w and other andother e v v aginosis (BV) and is often labeled as an ‘imbalance’ or ‘imbalance’ an as labeled is often (BV) and aginosis ywhere from a 2.2 from ywhere
xperimental models demonstrated that demonstrated models xperimental ed in both the female and male urinary tracts using using tracts urinary and male female the in both ed , a omen with more d more with omen a v n xpected inhabitants of the urinary tract using culture using tract urinary of the inhabitants xpected e v one of the common bacteria to bacteria one common the of e
w and cells’) [ cells’) , - e a wn wn mec omen and their babies [ babies their and omen v ginosis (BV) and UTIginosis (BV) and gues that the composition of a of composition that the gues o omen with a omen a r w microbiota. ely in recent years is the Nugent method [ method Nugent years is the in recent ely a ely to contain higher tite higher contain to ely v W k i V ]. Studies Studies ]. aginal fluid and the presence of epithelial cells studded with studded with cells of epithelial presence and the fluid aginal able 1, able bacterial bacterial aginal pH >4.5, ‘thin’ grayish homogenous homogenous grayish ‘thin’ pH >4.5, aginal aginalis v T v v e studies in studies e 223 xtens v , e Actinobacteria a vidence a vidence omen who are prone to recurrent UTI [ UTI recurrent to are prone who omen Author manuscript; e
. aginal microbiota because it has been associated with a wide a with associated been has it because microbiota aginal 222 w e also been obser been e also v vide compelling preliminary data that that data preliminary compelling vide v o a , our understanding of understanding , our y omen with BV h with BV omen Gardnerella w w pr aginal bacteria with UTI susceptibility in UTI susceptibility with bacteria aginal e’ molecules produced by lactobacilli may create may by lactobacilli produced e’ molecules o icial for for icial v , these results suggest a possible linkage between dysbiosis of the v independent approaches. These These approaches. independent f r i OH treatment of OH treatment e anaerobes, e anaerobes, criteria) include include criteria) - v ic ic K i f ], another possibility (though not a mutually a mutually not (though possibility another ], y of the bacterial genera that h that genera bacterial y of the w and illustrated in in illustrated w and Microbiol Spectr ed anaerobes in their urine than healt icient to yield clinical features and biochemical phenotypes of BV in a murine murine a in phenotypes of BV biochemical and features clinical yield to icient wer risk of UTI compared to to compared UTI risk of wer erse health outcomes for outcomes health erse at . Only recently h . Only recently o n f x o obiota, Bacterial obiota, Bacterial v g vironment h vironment f V r e n xperimental studies are needed to more fully understand the causal relationships linking linking relationships causal the understand fully more to are needed studies xperimental 229 e speci through speci act that lactobacilli possibility distinct [ unkn through act BV bacteria bel ma e culture be bene ab presented studies culture anaerobic of results with li more were UTI recurrent mi togethe bladder of the and dysbiosis Unfortunatel acid, lactic that It is thought limited. is infection tract urinary ‘defens the in uropathogens, including pathogens, potential upon ‘clue (i.e. mount wet in bacteria more used has been Gram using system scoring on a morphotype B bacterium, su [ model infection that found [ studied population on the depending n studies urogenital colonization states may influence the risk of UTI. the risk influence may states colonization urogenital clinical Mounting of UTI. risk her influences a l n as some by to is referred of the dysbiosis ad Amsel studies that demonstrate some un some demonstrate studies that 3) and urine, in detection bacterial for approaches independent wis e ginal Mic a V Kline and L
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f hemolytic, f l - oid life oid o This study r This study Denmark hospital yielded yielded hospital Denmark
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e viduals that present with present viduals that o
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e been characterized as resistant as resistant characterized e been F r
ic ic 236 v f yed in clinical microbiology labs, labs, microbiology in clinical yed – a Aerococcus e made it di made e o h e systemic infections in which in infections e systemic icant gr icant v were commonly misidenti were commonly f v
a i 230 ) UTI demonstrate that when patients when that UTI demonstrate Aerococcus [ species. The result is that aerococci are that aerococci result is The species. Aerococcus vide on 2 planes at right angles, angles, right at planes on 2 vide as
ely anaerobic, α anaerobic, ely i icant icant e and leucine aminopeptidase posit leucine aminopeptidase e and particula v anism, bacteriuria cleared and the patient the and cleared bacteriuria anism, f v
v is necessary to is necessary i n i g urinae
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y d ysiological similarities with lactococci, with lactococci, similarities ysiological atients with UTI caused by by UTI caused with atients ositive and and ositive month period in a in a period month at v e - h P urinae e g
P ]. In ]. viridans bacterial identi bacterial e
- ]. ]. can cause urinary tract infections and urosepsis, urosepsis, and infections tract urinary can cause n A.
- acultat A. f 238 ely contaminants. ely 237 GPC card, bioMérieux) to correctly identify 30 identify correctly to bioMérieux) card, GPC k Aerococcus of sanguinicola -
]. Molecular tools such as ampli as such tools Molecular ]. ainst the o ainst Aerococcus g Aerococcus A. ferent species of species ferent ailable in PMC 2016 June 01. f v pathogen in susceptible ind in susceptible pathogen 239 and the potential uropathogen uropathogen potential and the a e a
, v , we present s present , we and i anisms [ anisms e urological abnormalities or other risk risk other or abnormalities urological e r ted Gram
Aerococcus and oxidase and , g v xception
r r a ication of of ication - e f o fect
f ication of of ication y h gular clusters. Species of of Species clusters. gular f ging, or underreported, including species of of species including underreported, ging, or e” of detection by standard approaches. by standard detection of ]. Case reports of reports Case ]. n r e k repo li viridans - A, which are not commonly empl not commonly are which A, -
r 241 , and VITEK 2 ID 2 VITEK , and N and viridans group streptococci h streptococci group andviridans y of the cases described are i are described cases y of the getation, and are also common isolates from the human the human from isolates common also are and getation, , P A.
n
ve Author manuscript; Actinobaculum
. 240 eral species of eral species w discrimination [ discrimination w antibiotics e antibiotics v o ied and/or discarded as li as discarded and/or ied f e ]. Ma ]. e a number of biochemical and p ofbiochemical e a number v urinae,
is isolated from blood along with signi blood along is from isolated isolates (with the is a genus of microaerophilic, of is microaerophilic, a genus characteristic of aerococci is that th that is aerococci of characteristic a
Aerococcus 237 “ A. anisms may be missed as causes of UTI due to 1) misclassi due to of UTI causes be missed as may anisms , Aerococcus xt section of this chapte xt section
g , dust, and , dust, r e r , ID 32 STRE , ID 32 e cocci that are catalase are that e cocci ied with l with ied P 233 f v i , Microbiol Spectr anisms associated with BV could play a more direct role in the etiology of host etiology in the role direct more a play could BV with associated anisms wth of wth of o g r xamined the ability of three commonly used used of commonly three ability xamined the 230 ging, and Unde ging, and sequencing of 16S rR of sequencing accurate identi for needed are misclassi often identi and accurate Prompt potential by this infection systemic of isolates UTI. Most uncomplicated [ to sulfonamides with are treated [ Aerococcus h Aerococci [ streptococci and enterococci, pediococci, between tests. phenotypic routine using them between to distinguish e STRE di representing isolates tract urinary Aerococcus identi Aerococcus posit unique One irr and tetrads in resulting ai from S tract. urinary including a 4 during cultured urine specimens of all 0.8% gr and ma often elderly most In the n In the eme rare, that are bacteria Corynebacterium, o These signi of 2)dismissal criteria, phenotypic distinguishing or 3) lack contamination’, o tract. the urinary within interactions uropathogen as a cause of UTI of as a cause r wis , Eme e e ococcus ococcus r Ae Rar of UTI Etiologies Kline and L
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v e spectrum spectrum i
xperiencing no no xperiencing is treated byis treated - v or to cause encrusting encrusting to cause e irst described in described irst ].
e group D2) is the group is D2) f e urealyticum w
k Actinobacteria, o li 249 because the o the because - C.
acultat f ystitis and occur due to due and occur ystitis were ]; h ]; c ersion of urea to ammonia to ammonia of urea ersion are nonpathogenic. The The are nonpathogenic. e patients e patients
251 v as not recognized or e or as not recognized v anism [ anism urealyticum i , n
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250
yelitis, a chronic inflammatory inflammatory a chronic yelitis, ycline, ciprofloxacin, ofloxacin and ofloxacin ciprofloxacin, ycline, ]. Actinomyces p c encrusting Corynebacterium UTI also report that Gram UTI that also report urinae microbiota,” since it is generally is generally since it microbiota,”
, similar to other other to , similar
r diptheriae , with acute and chronic infections of infections chronic and acute , with
243 spore forming, forming, spore e y - , A. Corynebacterium urealyticum C. wed that 9.8% of renal tran of renal 9.8% that wed ov
]. ]. wn as o ampicin [ ampicin f vious treatment with broad with treatment vious o ]. 242 e , 245 ystitis and ystitis wth on blood a blood wth on , ication of the urinary tract, and treatment with with treatment and tract, urinary of the ication c 250 o realyticum Actinobaculum
f urealyticum 240
vious urological procedure and/or mucosal lesion mucosal and/or procedure urological vious ystitis caused by ystitis u vided, patients often progressed from simple UTI UTI simple from progressed often patients vided,
e eloping alkaline encrusted UTI. While this type of type this While UTI. encrusted alkaline eloping , c o 244 motile, non motile, v C. other than - irst detection of the o of the detection irst C. e e study sh e study f e bacilli and polymorphonuclear cells, despite routine routine despite cells, and polymorphonuclear e bacilli , which catalyzes the co catalyzes , which e. Molecular detection techniques can also be also can techniques detection e. Molecular v 235 viously kn viously ailable in PMC 2016 June 01. v y i v ut there is strong suspicion of encrusting of encrusting suspicion strong is ut there i , v e i anisms described as described as anisms b a
vit at g i splitting bacteria such as as such bacteria splitting r e, non (pr e, g - 234 v e v posit i i - Alkaline urine and the presence of struvite crystals in urine in urine crystals of struvite presence the and urine Alkaline
Encrusting Encrusting at
in urine, with nearly half of posit half of nearly with in urine, ]. . g and the species e
posit - , in other situations when when situations other , in 248 r Corynebacteria e – as not promptly pr promptly notas v e
urealyticum w eals Gram eals
ycline, erythromycin, and ri and erythromycin, ycline, 246 w Author manuscript; v c
al of encrustations, acidi ofal encrustations, . o e C. v y [ term hospitalization and/or pr and/or hospitalization term urealyticum urealyticum are Gram o -
infection can often be missed in routine urine culture urine routine in be missed often can infection
that are common components of the skin microbiota and increasingly increasingly and microbiota skin of the components that are common h
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requires at least 48 hours of gr of 48 hours requires least at yticum antibiotics. A number of reports document resistance of resistance document of reports A number antibiotics. l Actinobaculum xpression of urease act urease of xpression wing the isolation of o of the isolation wing n dioxide. The presence of a pr of a presence The n dioxide. e systemic infections [ infections e systemic e o wing and requires enriched media. More media. enriched requires and wing v i o haalii yed when tests are n are tests when yed gone long as ered fully; h fully; ered c o r v Microbiol Spectr n ov urealyticum w gr w
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315 e caution a caution e els considered signi considered els es in v v ystitis when these o these when ystitis W i e c collected urine when patients meet the threshold for UTI (10 for UTI the threshold meet patients when urine collected - r gery and later d later and gery posit aginal microbiota. microbiota. aginal e urine [ e urine r productus - v
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. e der bacteriuria at a bacteriuria der e cases of disseminated polymicrobial infection occur most often in in often most occur infection polymicrobial of disseminated cases at g iable concern to suspect contamination of the of the contamination suspect to concern iable or e f or GBS at l or GBS elihood of elihood F e uropathogen, it it e uropathogen, n k - v i ogens. In another related case, a case, a related another In ogens. actors. On one hand, the hand, one actors. On , since , since f xt of multiple other colo other multiple of xt r e of blad e of and GBS are often assumed to represent contamination of the urine specimen urine of the contamination to represent often assumed and are GBS studies are needed to de to are needed studies e e v omen were subjected to catheterization for urine collection. This study concludes study concludes This collection. urine for to catheterization subjected were omen
y i posit n aluate plates with polymicrobial gr polymicrobial with plates aluate w - ov
Microbiol Spectr ev ]. e culture e anisms present in both urine and blood and urine present in both anisms gically drained pus demonstrated a polymicrobial infection with infection polymicrobial a demonstrated pus drained gically ely to be members of the ‘normal’ microbiota that may be that may microbiota ‘normal’ of the be to members ely v r g k a r alid and justi and alid ulture as “contaminated,” identi as “contaminated,” ulture aecalis li as nonpath su urogynecological urine this of result the returned lab microbiology hospital Although insertion. catheter c su Peptostreptococcus of 20% to up that estimated been It has h across all patient groups. groups. patient all across unimportant. Gram 311 identical with infection bloodstream polymicrobial of cases cited multiple are There o UTI, polymicrobial of interpretation the supports infection bloodstream polymicrobial cases, o of the when multiple especially More risk underlying with persons compromised originating from the periuethral area during collection [ collection during area the periuethral from originating Gram of these titers same not were of cultures) 12% (in streptococci group B and of cultures) 10% (in that"enterococci predict H B streptococci).” for group and 0.272 Enterococcus Further and cathete midstream 2) the li ml), the cont potential roles as uropathogens, either in the classical sense or by predisposing the urinary urinary the predisposing or by sense classical the in either uropathogens, as roles potential diseases. urologic or other to infection tract signi clinical and biological The potential on ma v and/or periurethral not specimen. another and request f these bacteria). F bacteria). these animal in of infection studies wis e Urine “contamination” with mic normal Urine “contamination” Kline and L
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f f v omen without UTI [ UTI without omen v e sh k anisms and species assumed to represent contamination represent to assumed and species anisms a v e g w y a r v e presence of 5% CO of presence e o coli vity does not pr not does vity a independent approach performed in parallel r in parallel performed approach independent
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/ml urine, or “doubtful pathogens” at titers <10 titers at pathogens” or “doubtful urine, /ml ystitis h ystitis 4 xual act xual c e astidious o astidious aluating contested potential uropathogens in speci in uropathogens potential contested aluating fer from recurrent UTI, those at risk for complicated UTI, and those those and UTI, for complicated at risk recurrent UTI, those from fer f roblems of uncertain etiology (e.g. interstitial interstitial (e.g. etiology of uncertain roblems f ev icant titers of these o of these titers icant Author manuscript; xamined the incidence and signi and incidence the xamined
f . e fer from recurrent chronic episodes of episodes recurrent chronic from fer ystitis were more li were more ystitis e ar media for enumeration and identi and enumeration for ar media f omen who reported no history of s no history who reported omen c xample, Domann et al. found that 9.2% of urine specimens collected from from collected urine specimens of that 9.2% found et al. Domann xample, e UTI with >10 with e UTI v g , the term sterile is often applied incorrectly to these “culture these to incorrectly is often applied sterile term , the independent molecular approaches [ approaches molecular independent e ically ically v w a - y f i in urine specimens h in urine specimens , signi
e a or y y control groups: one with one groups: y control Actinobaculum v F i h el posit v i - ed anaerobes in their urine than healt than urine their in ed anaerobes xts. xts. x vidence of intact bacterial rods and/or cocci that were identi were that cocci rods and/or bacterial of intact vidence e e Microbiol Spectr 3 days, incubating plates in th in plates incubating 3 days, o healt aluated whether the urinary tract contains microbes that are not cult are that microbes contains tract urinary the whether aluated omen su who omen – indings suggest that that suggest indings w Clinical microbiology labs empl labs microbiology Clinical of select use the include approaches These specimens. urine of the analysis nonselect a of Incubation conditions. net to wider a slightly cast to approaches additional labs use Some clinical on depending often results, 2 f last In the specimens. urine of staining ev another with with another s that strongly suggest chronic recurrent with f cultures urine in specimens of urine speci studies who su as those such p urologic other with needed. still etc) are preeclampsia incontinence, contained contained h studies that Aerococcus respect as such uropathogens typical for culture anaerobic performed study recent Another w young aged of groups a similarly recurrent with of mi t Unfortunatel cont signi produce not did recipients renal transplant had culture using obser when infection be a monomicrobial culture by characterized when infection polymicrobial a where study a case detailed study recent one culture culture The results. lab clinical this patient from aspiration and suprapubic catheterization by collected specimens urine without a single dominant species (i.e. polymicrobial gr polymicrobial (i.e. species dominant single without a <10 at titers pathogens” ated” Bacterial Inhabitants of the Urina of the ated” Bacterial Inhabitants v wis e “Unculti Kline and L
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v . c ed using culture using ed i Lactobacillus ]. As with pr with As ]. o v e a wer d wer transplant recipients and recipients and transplant k ant ranges of >5×10 ant ranges v o ered from catheters were identi were catheters from ered act located in the bladde the located in act a were among the Gram the were among f vidence that microbes detected by detected that microbes vidence ev and 320 e l e , Domann et al. compared compared et al. Domann ,
e uting to this interpretation were collected (e.g. during UTI or prior to UTI). to prior or UTI during (e.g. collected were interpretation uting to this ov , v y b a rel - xamples of patients were pr were patients of xamples e els of bacteria such such bacteria of els independent denaturing high performance liquid chromatograp liquid performance high denaturing independent corresponding of the detection and method based - - v e for leu e e v i Microbiol Spectr anisms obser anisms ely to h to ely g k r aginal bacteria may inhabit the female urinary tract [ urinary tract female inhabit the may bacteria aginal aginal bacteria. The authors state that standard cur that standard state authors The bacteria. aginal routine methods. The authors concluded that catheterized patients who had a UTI were more more were a UTI who had patients catheterized that concluded authors The routine methods. li h not who did data contri d if higher clear not it is Thus, dr UTI of a presence the UTI or if b to demonstrate attempt In an in were tract adult asymptomatic from urine of composition bacterial v address adequately not does catch”) “clean (midstream method collection that the studies is with urine contamination of the possibility of line One by urine contamination of a product simply rec bacteria [ approaches r currently that are bacteria studies, high l polymicrobial, and polymicrobial, (see ab BV with associated lactolyticus of renal urines Fusobacteria posit by urine contamination of possibility the to opposed UTI as ofsymptomatic the cause v ma in that and method DHPLC the using urine CFU in to estimate clinically d bacterial assess o detection). independent’ In one stud culture PCR identify separate and [ urine specimens midstream from Interestingl UTI. risk for high culture that 9.2% demonstrate also signi contain to appeared yet approaches, culture of the Most approach. the DHPLC aerobic conditions used for urine culture. culture. for urine used aerobic conditions h that studies microbiome wis e Kline and L
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Streptococcus e also , and thus not thus , and Actinobaculum, r v independent approaches. These studies r studies These approaches. independent a - that speci vidence samples collected by direct needle aspiration from the bladde from aspiration needle by direct collected samples as subjected to anaerobic culture. 6.4% of these of these 6.4% culture. anaerobic to subjected as ould not be detected using typical aerobic urine culture and were were and culture urine aerobic typical using be detected ould not e eillonella act present in the genitourinary tracts of both men and and both men of tracts genitourinary the present in act e uropathogens (e.g. e uropathogens ]. Another recent study i study recent Another ]. anisms, more typical potential uropathogens were also r also were uropathogens potential typical more anisms, f A in urine, in urine, A w V w v g i N r e and Gram e and 323 v ication and sequencing. Surprisingl and sequencing. ication i , f and Gardnerella, Atopobium, Actinobaculum, ations h ations idobacterium
posit f g w whether the bacteria are al are the bacteria w whether - Author manuscript; detected in urine specimens obtained by catheterization or aspiration or aspiration by catheterization obtained specimens in urine detected
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anaerobes that that anaerobes , including species of species , including w able 1) [ able y T gnant gnant indings are supported by a f by a are supported indings f ied from 21/23 urine urine 21/23 from ied e f icant gr icant what un f otella, e Microbiol Spectr anisms present in these specimens could often be obser be often could specimens these in present anisms wed that a subpopulation of urines collected by transurethral catheterization did not yield not yield did catheterization by transurethral collected urines of a subpopulation that wed v en directly from the bladde the from en directly g o e r k agina, periurethral area or distal urethra, often contains o contains often urethra, ordistal area periurethral agina, aginal or periurethral contamination. All urines used in the in used urines All contamination. orperiurethral aginal astidious astidious are present in young men that report h report that men young in present are pr data These in are routine approaches s through acquired necessarily notare with populations often in most infection, tract of urinary studies in case been reported also risk underlying of culture limitations major of the One kn possible to not D of microbial presence v procedures. microbiology clinical routine using i Independent s urethral of patterns Gram typical more Streptococcus (e.g. tract urogenital see etc, sh males, adolescent from specimens sulcus coronal Pr f bladde the enter not did that needlesticks in mock detected not som this stud These 185 pr urine their and aspiration genera of the members urine including their in anaerobes Clostridium ta v laboratory microbiology clinical the using sh signi Gram contained rR and 16S ampli O time, same the at collected specimens midstream Bacteria samples. genera anaerobic the included methods including midstream ‘clean catch,’ transurethral catheterization, and direct direct and catheterization, transurethral ‘clean catch,’ midstream including methods [ bladder the from aspiration suprapubic wis e and L Kline
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s could also be cultured in the laborator in the cultured be also s could gorical gorical ould therefore be important confounders that confounders be important therefore ould T e els depending on whether whether on depending els Gardnerel ysiological implications and h and implications ysiological v 4.72 [±2.86]). H [±2.86]). 4.72 aginal microbiota (e.g. presence or amounts of or amounts presence (e.g. microbiota aginal ]. O ]. ]. Whether these bacteria represent st represent bacteria these Whether ]. e h UC and demonstrated that ma and demonstrated UC ed between the cases and and controls. cases the between ed v omen in the control group, h group, the control in omen v e methods that still pr still that methods e Q vs no UTI 1.35 × 10 × UTI 1.35 no vs erage 14 years older than the control group (63 [±12] [±12] (63 group control the than older 14 years erage v
292 325 w i v ailable in PMC 2016 June 01. 5 actors c actors , crispatus a ypothesis that the urinary microbiome may contri may microbiome urinary that the ypothesis v f
as a h v ]. These authors demonstrated pr demonstrated authors These ]. o treatment arms of a arms o treatment n 292 e for bacterial D bacterial e for , using a cat , using w ferences in age and age in ferences v r ariety of p of ariety i f omen in the UUI group were more li more were UUI group in the omen 325 v aginal bacteria. The authors performed 16S rD 16S performed authors The bacteria. aginal , xpanded quantitat xpanded w v inition at the time of urin of time at the inition Corynebacterium, These ]. e
f , arding a condition (UUI) of uncertain etiology uncertain of (UUI) condition a arding ferent from from ferent r ferences obser ferences 292 f iles. Thus, subsequent studies used cathete used studies subsequent Thus, iles. g , the authors also performed E performed also authors , the f f 327 e y , Lactobacillus in their bladders compared to to compared bladders in their 0.05). Di 0.05).
as the least i the least as e a wide wide e a geting the 16S ribosomal D 16S ribosomal the geting act di act omen posit omen r v Author manuscript; used an used an w e for bacteria presence. Only Only presence. e for bacteria f
326 a . e microbial community?” community?” e microbial w v omen by transurethral catheterization and by suprapubic aspiration had aspiration suprapubic by and catheterization by transurethral omen based) de based) i viding a truly multidisciplinary approach to pr to approach multidisciplinary a truly viding iling in parallel with E with parallel in iling v - i f asseri and greater proportions of proportions and greater w o ving in the bladder still remains to be fully characterized. be fully to remains still bladder the ving in at y incontinence (UUI) [ (UUI) y incontinence i g ferences in median qPCR l qPCR in median ferences c g
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ute to the di to the ute ic phenotypic features of the of the features phenotypic ic b as successful. Rathe successful. as f gen r e of a l of a e w ined as noninfectious. The authors conclude that the urinary microbiomes of urinary microbiomes that the conclude authors The noninfectious. as ined ely to harbor to ely ield, pr ield, f microbiome pro microbiome v er recently recently er f k i e or n e yed qPCR ta qPCR yed k icant di icant v ered in laboratory culture [ culture laboratory in ered o i f Microbiol Spectr vious assumptions r assumptions vious ov Lactobacilli e as not contaminated with with as not contaminated ersus 49 [±14]; P < 49 [±14]; ersus arious bacteria) [ bacteria) arious empl posit (culture clinical stud qPCR the in included were randomization signi ×10 2.58 UTI (UTI procedure a post for UUI that demonstrate vs (5.71[±2.60] episodes of UUI number bacteria detected using molecular approache molecular using detected bacteria group UUI that the is of this study limitation potential on being despite estrogen, be using v h status hormonal with speci v contri may of population same the used groups the same from study Another to t randomized who were UUI urinary u urinary for the pr been de in were UUI with of Aerococcus, that reports paper also This Lactobacillus li more stud of this component this important question [ question this important from collected similar this because urine w pro community by culture urine catheterized in detected bacteria rec l communities pro community performed recently most group This same the to test samples urine collected indicat Bruba wis e Kline and L
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. described in urine microbiome studies (see studies (see microbiome urine in described associated e f e ied as h as ied ypotheses related to the potential roles of urogenital of roles potential to the related ypotheses e, the presence of clue cells (i.e. squamous epithelial cells cells epithelial squamous (i.e. of clue cells presence the e, - V f ng s v h may attach itself to epithelial cells of the urethra and bladder bladder and urethra of cells the itself to epithelial attach may a wed the epidemiology and virulence characteristics of the of the characteristics virulence and epidemiology the wed ations that that ations
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, inhabitants of the human urinary tract, and 4) presented presented and 4) tract, urinary human of the inhabitants a e been dispr been e 347. [PubMed: 11294737] 347. [PubMed: er CJ. Group B streptococcal infections in elderly adults. Clin Infect Dis. 2005; Infect Dis. adults. elderlyClin in Group B infections CJ. streptococcal er v . The. Predict as thought that the major uropathogenic o uropathogenic the major that as thought en years ago it it years ago en – Author manuscript; k a F , D
. w T P . 2011; .9:286 2011; 231. [PubMed: 18314207] [PubMed: 231. r yene G, Melaku S, S, Ts yene Melaku G, aecalis – ambyah ambyah f e T aediatrics: dipstick adequate for febrile UTI test. Nat UTI test. Nat R febrile adequate for aediatrics: dipstick
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w 11. Matth 12. Be 13. DG, Maki 14. Jain 5. Jido 6. Mehnert Majid 7. Al Shu A, 8.Z, Peisakh Arinzon 9. 10. Ed microbiota in the urinary tract, tract, urinary the in microbiota Clinical practice. TM. 1. Hooton P Chang 2. Schroeder AR, 3. M. Clyne 4. Demilie ov common are bacteria i infections polymicrobial pr years Fifty posit Currentl n t assumption. last the question into calls in this chapter summarized a pr illuminate will studies Enterococcus w reasons and the uropathogens common less wis e erences f Re Kline and L
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actinomycosis associated with bilateral necrosing renal necrosing bilateral with associated actinomycosis e
ransm Dis. 2013; 40:944 ransm 1):S23 659. [PubMed: 20715676] 659. [PubMed: v of N. the kidnMycoplasma infections T – ailable in PMC 2016 June 01. w C, Lee D, Hor w C,Lee D, o v a x y man: case report and characterization of the isolate. J ythe isolate. of characterization and case report man: a yte esterase testing of yte testing of esterase . Renal . Renal e , H. Goossens S ransm Dis. 25:448 1998; ransm r unilateral emp unilateral c h P
T ezhd er I. Gardnerella er Gardnerella I. oz H AM, Artese ener Z, Kadioglu A, Ang O. Bacterial pathogens in male patients inpatients male Ang O. pathogens A, enerBacterial Kadioglu Z, x k F v . J Clin Microbiol. 2009; 47:1871 2009; Microbiol. . J Clin yelonephritis caused e ov y p ec vrat Q, Guillaume Guillaume Q, vrat aik SS. Primary aik SS. Primary 806. [PubMed: 18057138] 806. yelonephritis. Dtsch Med yelonephritis. Dtsch Med e 254. [PubMed: 254.8088884] [PubMed: as in bacteria men: associated P – p W - – ul. S ul. anisms in the male urethra. Zentralbl Bakteriol Mikrobiol Hyg [A]. 1988; [A]. Hyg Zentralbl Mikrobiol Bakteriol in the anisms urethra. male b 165. [PubMed: 15800097] g r ication of 14 genital microo of ication 14 – f ransm Infect. 2005; 81:458 Infect. ransm a Bel C, . Acute viously healt viously gonococcal urethritis in heteros in gonococcal urethritis v T e abrizi S, Bradsh abrizi - . PLoS One. 2014; 9:e98271. [PubMed: 24870125] . 9:e98271. One. 2014; PLoS Y idan Gü idan A, o en J, Gentens J, en Gentens Horn M, Menninger M, Held E, Heesemann J. Mycoplasma hominis. A rare J. E, Heesemann Mycoplasma Menninger Held Horn M, M, f T x - w v k aginosis e Author manuscript; , Jun YJ, , e e
838. [PubMed: 18073017] [PubMed: 838. 113. [PubMed: 3414078] [PubMed: 113. v aç . ransm Dis. 1983; 10(Suppl):323 ransm 78. [PubMed: [PubMed: 15681728] 78. – – g ala vi W aiphei K. Renal actinomycosis. BMJ Case 2014 pii:bcr2014205892. BMJ Rep. aipheiactinomycosis. Renal K. asuda M, Ito S, asuda Maeda S, M, D S, Ito T – e T uen K
C. Occurrence and pathogenicity of Mycoplasma hominis in the upper urinary tract: a tract: in hominis urinary the upper of pathogenicity Mycoplasma and C. Occurrence V Y erho C,L, Chambrone x Y iens PR, Ng B, Reimer A, Burdz Burdz A, Reimer PR, B, Ng iens ,
erse line assa line erseblot A e V Hartmann Hartmann AA, A P smears to identify Mycoplasma genitalium identify to Mycoplasma smears . Acta Cytol. 2010; 54:658 Acta Cytol. . v 63. e agent of acute e agent a I, a I,
, W y e – 63. [PubMed: 63.7603755] [PubMed: v v - . S . P i al – o , Read TH, , Read w echnie ML, Hillman R, Couldwell D, Hillman ML, R, echnie w e P a acé K en M, en M, g vi ong SS, ong SS, v umar B, Sharma M. Carriage of Gardnerel M. umar B,Carriage Sharma ytolog ydin MD, A ydin MD, e alk L, Fredlund H, Jensen JS. Signs and symptoms of urethritisan and Signs Jensen JS. alksymptoms L, Fredlund H, e transmittable transmittable microo 269:56 infection. S trachomatis or Mycoplasma Chlamydia genitalium with or without 2005; 81:73 cervical 2007; 18:835 Antimicrob 24(Suppl 2004; Agents. systematic r 1988; 27:110 causat 9190301] r 27:61 transmission. S papillitis. Int Urol Nephrol. 1980; 12:199 Nephrol. 1980; Urol papillitis. Int of course Lesieur O. Fulminant m caused by actinomycosisActinomyces 25878793] [PubMed: Care.2:42. 2014; c 22:157 1996; Infect Dis. case Clin report. a after periodontal bloodstream procedures: in the pathogens periodontal Dissemination of with urethritis in Istan in with urethritis of non Symptoms Infect. 81:163 2005; Med 1994; 99:252 Res. Simultaneous identi based r DN. Bacterial S with urethritis. nongonococcal bacteremia in a pr in bacteremia 46:804 Microbiol. 2008; F W Horliana Horliana A K Microbiol Spectr 374. E. Leuco Kihlström 375. M, Högdahl 376. Ishihara S, 368. Angel Abele 369. Küchle C, 370. Thomsen 371. pr Mycoplasma JS. genitalium: Jensen Loré B, 372. C, Anagrius 373. Elsner 362. Agr L J J, Surján 363.J, Galambos Juhász M, L 364. Leloup Herbland A, Na 365.SM, Jang 366. I 367. 357. 358. Iser 359. 360. Mc C Gillespie C, Liu 361. LE, CM, Khosropour Manhart 356. La wis e Kline and L
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P ylori: ylori: 1101. p – elch RA. murine murine onaka H, onaka H, K W 18. [PubMed: [PubMed: , – Y 221. [PubMed: 221. 492. 492. – –
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. 2006; 70:192 2006; . . 2011; .17:487 2011; r v e ransm Infect. 2009; 85:15 2009; Infect. ransm T x e 67. [PubMed: 12823810] [PubMed: 67. – , Furubayashi K, Shimamura M, Maeda Shimamura Furubayashi , K, .; Mendz, GL.; Hazell, SL., editors. Helicobacter editors. Helicobacter Hazell, SL., .; Mendz, GL.; vitt M, Stamm WE. Clinical and microbiological features features microbiological Clinical and WE. M, Stamm vitt serine deaminase to modulate infection of the the of infection to serine deaminase modulate T alence of genital Mycoplasma, Ureaplasma, Gardnerella, Ureaplasma, Mycoplasma, alence of genital T - a L Ke ev ailable in PMC 2016 June 01. w wind O. Sortases and the art of anchoring proteins to the proteinsto the art anchoring the of and O. Sortases wind v a e , H a g A. Mycoplasma genitalium is associated with symptomatic and and symptomatic genitalium associated is with A. Mycoplasma y
e ashington, DC: ASM Press; Press; 2001.179 ASM p. ashington, DC: Schne
W e bacteria. Microbiol Mol e Biol R bacteria. Microbiol Mol virus infection. J Infect Chemothe J Infect virus infection. a v C, i A virus in Japanese men with urethritis, and risk urethritis, and risk with Japanese men virus in , Batchelet S, Moritz RL, Pellett S, Haugen BJ, FR, Blattner S, RL,BJ, Haugen Moritz Pellett S, Batchelet , a P
gonococcal urethritis in men. S men. in urethritis gonococcal posit - - aguchi Sasa S, w oh E, Namiki M. Pr oh E, Namiki M. Author manuscript; a
. K . Urease. In: Mobl In: . Urease. T
L ini LA, Dedent ini , H , y ff kami A, kami A, e elopes gram of ysiologyand Genetics. v ong ES, Hooton TM, Hooton CC,Hill TM, Mc ong ES, h n Uropathogenic Escherichia coli use d coli use Uropathogenic Escherichia 49:55 2003; Microbiol. urinary tract. Mol Mizo and papillom human urethral papillom human 21213011] in J Dis. 158:1098 1988; urethritis Infect men. nongonococcal of recurrent persistent or [PubMed: 3183419] e 16524923] P asymptomatic non 18842690] W Microbiol Spectr 382. Roesch PL, 382. Redford PL, Roesch 378. Shigehara K, K 378. Shigehara 379. 380. Marra 381. Mobl 377. Moi H, Reinton N, Moghaddam N, 377.Reinton Moi H, wis e Kline and L
Author Manuscript Author Manuscript Author Manuscript Author Manuscript Kline and Lewis Page 47
Describes Staphylococcus, Enterococcus, and Streptococcus as uropathogens, discusses :l> c polymicrobial urinary tract infection, the significance of polymicrobial growth upon urine ::r -0 culture, and the potential under-reporting of fastidious organisms and atypical Gram• positives as causes of urinary tract infection. Finally, this chapter summarizes current
literature regarding the microbiota of the urinary tract and discusses the potential role of urogenital microbiota in UTI susceptibility.
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Author Manuscript Author Manuscript Author Manuscript Author Manuscript Table 1
Genera of Gram-positive human urinary tract inhabitants and pathogens detected by culture-dependent and –independent techniques L and Kline
“culture negative” means specimens that did not reach the cutoff value, usually 105 CFU/ml urine in a clean catch specimen or 104 CFU/ml for collections by catheter or suprapubic aspiration.
e wis Culture-Dependent Culture-Independent Detection in Urinary Tract Clinical Reports
Female, Female, Female culture-negative, Male Male
Microbiol Spectr Microbiol culture culture nitrite and leukocyte esterase asymptomatic symptomatic Bladder/ Bacteremia Phylum Genus Kidney & Urethritis unknown positive negative or asymptomatic
infection Urosepsis urethral TUC CC,TUC CC TUC SPA urine urine swab
[319, 5–20% of 53 55
. [ , , 328 292 329 318 319 317 329 317 322 323 330 Author manuscript; Author Staphylococcus 47 [ ] [ , ] n/r [ , ] [ , ] [ ] – [ ] [ ] CAUTI [ ] 56] 324]
15–30% of 322 Enterococcus CAUTI 328 331 332 318 316 333 319 n/r n/r [ , 323 330 [ ] [ , ] [ ] [ , ] [ ] 323 [ ] [ ] [13, 115, 119] ]
1–2% of UTI [292, 318, [316, 318, [322– a Streptococcus 180 334 n/r 317 329 317 323 330 v 180 [ ] [ ] 329 319 [ , ] [ ] 324 [ ] [ ] ailable in PMC 2016 June 01. June 2016 in PMC ailable [ ] ] ] ]
[319, [230, 232, 237, [233–236, Aerococcus n/r 329[ ,335 ] [317 ] [318 , 319 ] [317 ] [317 ] 322 , [323 ] n/r 239] 278] 323]
Firmicutes [319, [292, 329, [316, 318, Anaerococcus n/r n/r n/r [333 ] n/r [317 ] 322 – [323 ] n/r 335] 319, 333] 324]
319 [ , Peptostreptococcus [321, 336]* [337] n/r [335] [333] [318, 319] n/r n/r 322, n/r n/r 324]
319[ , Peptoniphilus n/r [338] n/r [335] [333] [317–319] n/r n/r n/r n/r 322]
[319, [321, 339, [316–319, Lactobacillus n/r n/r [335 ] [333 ] [317 , 329 ] [317 ] 322 – [323 ] [330 ] 340] * 333] 324]
P
age 53 age
Culture-Dependent Culture-Independent Detection in Urinary Tract Clinical Reports L and Kline Female, Female, Female culture-negative, Male Male Bladder/ Bacteremia culture culture nitrite and leukocyte esterase asymptomatic symptomatic Phylum Genus Kidney & Urethritis unknown positive negative or asymptomatic
infection Urosepsis e
urethral wis TUC CC,TUC CC TUC SPA urine urine swab
[319, 317 318 Finegoldia n/r n/r n/r 335 [ , , 319 n/r 317 322 323 330 [ ] 333 [ ] [ ] – [ ] [ ] ] 324
Microbiol Spectr Microbiol ]
337 322 Veillonella 341 342 [ , n/r 335 317 n/r 292 329 n/r [ , 324 n/r [ , ] 341 [ ] [ ] [ , ] 323 [ ] ] ] [319, 343 323 . Gemella n/r n/r n/r n/r n/r n/r n/r 322 n/r [ ] , [ ]
Author manuscript; Author 323]
[319, [246–249, 344– [292, 329, [316, 318, Corynebacterium 350[ ] 351[ –353 ] n/r [317 , 329 ] [317 ] 322 , [323 ] n/r 349] 335] 319] 323]
155 261 262 a [ , , , 270 v [ , ailable in PMC 2016 June 01. June 2016 in PMC ailable 266, 267, 269, 292[ ,317 , Actinobaculum 275, 278, n/r [335] [317, 333] [318, 319] [317 ] [322 ] n/r n/r 272, 274, 276, 329] 355] 277, 354]
[293, [317, 322– Actinobacteria 307[ –309 , [316 , 318 , [319 , Gardnerella [285, 300]* 300, 303, [335 ] [333 ] 324, 329, [317] [323 ] n/r 357–359] 319, 333] 322] 356] 360]
[319, 317 319 292 317 Atopobium n/r n/r n/r 335 333 [ , , [ , , 317 322 323 361 [ ] [ ] 333 329 [ ] , [ ] [ ] ] ] 323, 361]
Actinomyces [362–366] [367] n/r [335] n/r [319] [292] n/r [322] n/r n/r
Bifidobacterium n/r n/r n/r [335] [333] n/r [292, 329] n/r n/r n/r [330]
[319, [358 , 372 – Mycoplasma [368–371] n/r n/r n/r n/r n/r n/r 322, [323] n/r 379] 323]
n/r = not reported, CAUTI = community acquired UTI,
P * 54 age Questionable clinical significance, CC = clean catch, TUC = transurethral catheter, SPA = suprapubic aspiration.