International Urogynecology Journal

, Volume 29, Issue 12, pp 1797–1805 | Cite as

Urinary microbes and postoperative urinary tract infection risk in urogynecologic surgical patients

  • Krystal J. Thomas-White
  • Xiang Gao
  • Huaiying Lin
  • Cynthia S. Fok
  • Kathryn Ghanayem
  • Elizabeth R. Mueller
  • Qunfeng Dong
  • Linda Brubaker
  • Alan J. Wolfe
Original Article


Introduction and hypothesis

Women have a 20% risk of developing a urinary tract infection (UTI) following urogynecologic surgery. This study assessed the association of postoperative UTI with bacteria in preoperative samples of catheterized urine.


Immediately before surgery, vaginal swabs, perineal swabs, and catheterized urine samples were collected, and the V4 region of the 16S ribosomal RNA (rRNA) gene was sequenced. The cohort was dichotomized in two ways: (1) standard day-of-surgery urine culture result (positive/negative), and (2) occurrence of postoperative UTI (positive/negative). Characteristics of bladder, vaginal, and perineal microbiomes were assessed to identify factors associated with postoperative UTI.


Eighty-seven percent of the 104 surgical patients with pelvic organ prolapse/urinary incontinence (POP/UI) were white; mean age was 57 years. The most common genus was Lactobacillus, with a mean relative abundance of 39.91% in catheterized urine, 53.88% in vaginal swabs, and 30.28% in perineal swabs. Two distinct clusters, based on dispersion of catheterized urine (i.e., bladder) microbiomes, had highly significant (p < 2.2–16) differences in age, microbes, and postoperative UTI risk. Postoperative UTI was most frequently associated with the bladder microbiome; microbes in adjacent pelvic floor niches also contributed to UTI risk. UTI risk was associated with depletion of Lactobacillus iners and enrichment of a diverse mixture of uropathogens.


Postoperative UTI risk appears to be associated with preoperative bladder microbiome composition, where an abundance of L. iners appears to protect against postoperative UTI.


Urinary tract infection Urobiome Surgical infection Postoperative infection 



We kindly thank Mary Tulke RN for her assistance with participant recruitment and sample collection; we thank Noriko Shibata MS for her assistance with sample analysis. We also thank Dr. Michael Zilliox and Gina Kuffel of the Loyola Genomics Facility for performing the DNA sequencing.


This study was supported by a grant from the Falk Foundation (LU#202567) and by NIH grants R21 DK097435 and P20 DK108268.

Compliance with ethical standards

Conflicts of interest

Dr. Wolfe discloses research support from Astellas and Kimberly Clark; Dr. Mueller discloses research support from Astellas and Boston Scientic. The remaining authors (Thomas-White, Gao, Lin, Fok, Ghanayem, Dong, and Brubaker) report no disclosures.

Supplementary material

192_2018_3767_MOESM1_ESM.docx (57 kb)
ESM 1 (DOCX 56 kb)


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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Krystal J. Thomas-White
    • 1
    • 2
  • Xiang Gao
    • 3
  • Huaiying Lin
    • 3
  • Cynthia S. Fok
    • 4
    • 5
  • Kathryn Ghanayem
    • 1
  • Elizabeth R. Mueller
    • 4
  • Qunfeng Dong
    • 3
  • Linda Brubaker
    • 4
    • 6
  • Alan J. Wolfe
    • 1
  1. 1.Department of Microbiology and Immunology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  2. 2.Department of Microbiology and ImmunologyStanfordUSA
  3. 3.Department of Public Health Sciences, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  4. 4.Departments of Obstetrics & Gynecology and Urology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  5. 5.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  6. 6.Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive SurgeryUniversity of California San DiegoLa JollaUSA

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