Fostering Unrinary Microbiome Health in Older Adults to Reduce Urinary Tract Infections

Rebecca M. Goodwin

PhD Student, College of Nursing

April 20, 2021

An increasing focus on the health of older adults and inclusion of older adults in biomedical research is consistent with efforts by the National Institutes of Health to fund research across the lifespan.

Urinary tract infections (UTI) are common in older adults, but can be difficult to diagnose. One indicator of UTI in institutionalized older adults is behavioral changes (e.g., delirium), but it can be more difficult to identify those changes in people who already exhibited such behaviors related to other conditions (e.g., cognitive impairment/dementia).

 

Asymptomatic bacteriuria (ASB) may protect against urinary tract infection, and ASB is highly prevalent in institutional older women with incontinence (80%). However, further compounding the challenge of UTI diagnosis is that presence of ASB in the urinary tract can make urine dipstick tests for acute UTI show positive culture results. The positive test results can then lead to overuse of antibiotics.

 

Overuse of antibiotics can wreak havoc on an individual's microbiome by destroying beneficial or protective bacteria. In turn, this can increase the number of disease-causing (pathogenic) bacteria, and make those pathogenic bacteria increasingly resistant to antibiotics.

 

Microbiome research may be helpful in improving prevention, diagnosis, and treatment of acute and recurrent UTIs by helping to differentiate between harmful and helpful microbes in the urinary tract, also known as the urobiome.

 

As the population in the United States continues to age, urobiome research is increasingly important to improve the health and comfort of older adults by identifying novel ways to prevent and treat acute UTI. The research community should continue to consider ways to weave together innovative models and techniques for UTI prevention and treatment with traditional wisdom and therapies. For example, fermented foods and drinks have been touted as beneficial for the gut microbiome; they may also benefit the diversity and health of the urobiome. Additional research is also needed to explore alternative therapies to avoid overuse of antibiotics, such as bacteriophage therapy.

(Biggel et al., 2019; Godbole et al., 2020a, 2020b; Pannek, 2020; Sybesma et al., 2016; Thomas-White et al., 2018; Wainwright et al., 2010; Wolfe & Brubaker, 2019)

 

Recommended Readings:

 

Biggel, M., Heytens, S., Latour, K., Bruyndonckx, R., Goossens, H., & Moons, P. (2019). Asymptomatic bacteriuria in older adults: The most fragile women are prone to long-term colonization. BMC Geriatrics, 19(1), 170. https://doi.org/10.1186/s12877-019-1181-4

Godbole, G. P., Cerruto, N., & Chavada, R. (2020a). Assessment and management of urinary tract infections in older adults. https://doi.org/10.1002/jppr.1650

Godbole, G. P., Cerruto, N., & Chavada, R. (2020b). Principles of assessment and management of urinary tract infections in older adults. Journal of Pharmacy Practice and Research, 50(3), 276–283. https://doi.org/10.1002/jppr.1650

Pannek, J. (2020). Prevention of Recurrent Urinary Tract Infections in Neurourology. In European Urology Focus (Vol. 6, Issue 5, pp. 817–819). Elsevier B.V. https://doi.org/10.1016/j.euf.2020.01.015

Sybesma, W., Zbinden, R., Chanishvili, N., Kutateladze, M., Chkhotua, A., Ujmajuridze, A., Mehnert, U., & Kessler, T. M. (2016). Bacteriophages as potential treatment for urinary tract infections. Frontiers in Microbiology, 7(APR). https://doi.org/10.3389/fmicb.2016.00465

Thomas-White, K. J., Gao, X., Lin, H., Fok, C. S., Ghanayem, K., Mueller, E. R., Dong, Q., Brubaker, L., & Wolfe, A. J. (2018). Urinary microbes and postoperative urinary tract infection risk in urogynecologic surgical patients. International Urogynecology Journal, 29(12), 1797–1805. https://doi.org/10.1007/s00192-018-3767-3

Wainwright, M., Stanforth, A., Jones, R., Loughran, C., & Meegan, K. (2010). Photoantimicrobials as a potential local approach to geriatric UTIs. Letters in Applied Microbiology, 50(5), 486–492. https://doi.org/10.1111/j.1472-765X.2010.02825.x

Wolfe, A. J., & Brubaker, L. (2019). Urobiome updates: advances in urinary microbiome research. In Nature Reviews Urology (Vol. 16, Issue 2, pp. 73–74). Nature Publishing Group. https://doi.org/10.1038/s41585-018-0127-5

 

 

 

 

Keywords/Tags/Concepts: older adults, gerontology, geroscience, microbiome, microbiota, urobiome, urine microbiota, urinary tract health, human urinary microbiome, enhanced urine culture techniques, fermentation, probiotics, antibiotic overuse, multidrug resistant organisms (MDROs),