Centre for Human Microbiome and Probiotic Research, Lawson Health Research Institute, London, ON, Canada.
Department of Microbiology and Immunology, The University of Western Ontario, London, ON, Canada.
Cell Rep Med. 2020 Sep 22;1(6):100094. doi: 10.1016/j.xcrm.2020.100094.
Ureteral stents are commonly used to prevent urinary obstruction but can become colonized by bacteria and encrusted, leading to clinical complications. Despite recent discovery and characterization of the healthy urinary microbiota, stent-associated bacteria and their impact on encrustation are largely underexplored. We profile the microbiota of patients with typical short-term stents, as well as over 30 atypical cases (all with paired mid-stream urine) from 241 patients. Indwelling time, age, and various patient comorbidities correlate with alterations to the stent microbiota composition, whereas antibiotic exposure, urinary tract infection (UTI), and stent placement method do not. The stent microbiota most likely originates from adhesion of resident urinary microbes but subsequently diverges to a distinct, reproducible population, thereby negating the urine as a biomarker for stent encrustation or microbiota. Urological practice should reconsider standalone prophylactic antibiotics in favor of tailored therapies based on patient comorbidities in efforts to minimize bacterial burden, encrustation, and complications of ureteral stents.
输尿管支架通常用于预防尿路梗阻，但会被细菌定植并形成结石，导致临床并发症。尽管最近对健康尿路微生物组进行了发现和描述，但支架相关细菌及其对结石形成的影响在很大程度上仍未得到充分探索。我们对具有典型短期支架的患者以及来自 241 名患者的 30 多个非典型病例（均有配对的中段尿）的微生物组进行了分析。留置时间、年龄和各种患者合并症与支架微生物组组成的改变相关，而抗生素暴露、尿路感染 (UTI) 和支架放置方法则不相关。支架微生物组很可能来源于常驻尿路微生物的粘附，但随后会分化为一个独特且可重复的群体，从而否定了尿液作为支架结石或微生物组的生物标志物。泌尿科治疗应重新考虑单独使用预防性抗生素，而应根据患者合并症采用针对性治疗，以尽量减少细菌负担、结石形成和输尿管支架并发症。
