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Urine trouble: should we think differently about UTI?

Abstract

Urinary tract infection (UTI) is clinically important, given that it is one of the most common bacterial infections in adult women. However, the current understanding of UTI remains based on a now disproven concept that the urinary bladder is sterile. Thus, current standards for UTI diagnosis have significant limitations that may reduce the opportunity to improve patient care. Using data from our work and numerous other peer-reviewed studies, we identified four major limitations to the contemporary UTI description: the language of UTI, UTI diagnostic testing, the Escherichia coli-centric view of UTI, and the colony-forming units (CFU) threshold-based diagnosis. Contemporary methods and technology, combined with continued rigorous clinical research can be used to correct these limitations.

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Acknowledgements

We would like to thank the members of the Loyola Urinary Education and Research Collaborative for their contributions to the work described.

Funding

AJW, LB, and ERM have been supported by NIH grants 2 U10 HD41250, U01 DK58229, R21 DK097435, R56 DK104718, P20 DK108268, R01 DK104718, a translational grant from the Falk Foundation and by RFC LU206998 from Loyola University Chicago. AJW has received funding for Investigator Initiated Studies VESI-12D01 and MYRB-15A01 from Astellas Scientific and Medical Affairs Inc. ERM has received funding from an Investigator Initiated Study (VESI-12D01) from Astellas Scientific and Medical Affairs Inc. Our funding sources have played no role in the design or conduct of our studies; collection, management, analysis, and interpretation of our data; or in the preparation, review, or approval of this or any other manuscript.

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Correspondence to Linda Brubaker.

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Conflicts of interest

Dr Brubaker has received editorial honoraria from UpToDate and Female Pelvic Medicine and Reconstructive Surgery. Dr Wolfe has received research support from Astellas Scientific and Medical Affairs. for urinary microbiome research. Dr Mueller has received honoraria from UpToDate and honoraria and research support from Astellas Scientific and Medical Affairs. Drs Brubaker and Wolfe have received funding from the NIH and Loyola University Chicago for urinary microbiome research (see funding acknowledgements). Travis Price, Evann Hilt, and Tanaka Dune have no conflicts of interest.

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Price, T.K., Hilt, E.E., Dune, T.J. et al. Urine trouble: should we think differently about UTI?. Int Urogynecol J 29, 205–210 (2018). https://doi.org/10.1007/s00192-017-3528-8

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Keywords

  • Diagnostics
  • Escherichia coli
  • Microbiome
  • Pathogens
  • Urinalysis
  • Urinary tract infection