Miller Sophie J, Carpenter Lucy, Taylor Steven L, Wesselingh Steve L, Choo Jocelyn M, Shoubridge Andrew P, Papanicolas Lito E, Rogers Geraint B
Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Infection and Immunity, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
Commun Med (Lond). 2024 Aug 16;4(1):164. doi: 10.1038/s43856-024-00583-y.
Urinary tract infections (UTI) are the most frequently diagnosed infection in residents of long-term care and are a major risk factor for urosepsis, hospitalisation, and death. Translocation of gut pathobionts into the urinary tract is the presumed cause of most UTIs. While specific gut microbiota characteristics have been linked to UTI risk in younger adults, their relevance in aged care residents remains uncertain.
The faecal microbiome was assessed in 54 long-term aged care residents with a history of UTIs and 69 residents without a UTI history. Further comparisons were made to microbiome characteristics in 20 younger adults without UTIs. Microbiome characteristics were examined in relation to prior and subsequent UTIs, as well as antibiotic therapy.
In long-term aged care residents, prior UTI history and exposure to UTI-exclusive antibiotics do not significantly affect microbiome composition or functional capacity. However, exposure to antibiotics unrelated to UTI treatment is associated with distinct microbiota compositional traits. Adjustment for dementia, incontinence, diabetes, and prior antibiotic use finds no microbiota characteristic linked to UTI development. However, prior UTI is identified as a predictor of future UTIs. Comparison with younger adults identifies greater within-participant dispersion in aged care residents, as well as lower microbiota diversity and altered microbiome functional potential.
No association between the gut microbiome and UTI incidence, as has been reported in younger individuals, is evident in long-term aged care residents. Considerable variability in gut microbiome characteristics, relating to high antibiotic exposure and age-related physiological and immunological factors, could mask such a relationship. However, it cannot be discounted that increased UTI risk in the elderly is independent of microbiome-mediated mechanisms.
尿路感染（UTI）是长期护理机构居民中最常被诊断出的感染，并且是导致泌尿道脓毒症、住院和死亡的主要危险因素。肠道致病共生菌转移至泌尿道被认为是大多数尿路感染的病因。虽然特定的肠道微生物群特征与年轻成年人的尿路感染风险有关，但其在老年护理机构居民中的相关性仍不确定。
对54名有尿路感染病史的长期老年护理机构居民和69名无尿路感染病史的居民进行粪便微生物群评估。并与20名无尿路感染的年轻成年人的微生物群特征进行进一步比较。研究了微生物群特征与既往及随后的尿路感染以及抗生素治疗之间的关系。
在长期老年护理机构居民中，既往尿路感染病史和接触专门用于治疗尿路感染的抗生素不会显著影响微生物群组成或功能能力。然而，接触与尿路感染治疗无关的抗生素与独特的微生物群组成特征有关。对痴呆、失禁、糖尿病和既往抗生素使用情况进行调整后，未发现与尿路感染发生相关的微生物群特征。然而，既往尿路感染被确定为未来尿路感染的一个预测因素。与年轻成年人相比，老年护理机构居民个体内的离散度更大，微生物群多样性更低，微生物群功能潜力也有所改变。
在长期老年护理机构居民中，未发现肠道微生物群与尿路感染发生率之间存在如在年轻人中所报道的关联。与高抗生素暴露以及年龄相关的生理和免疫因素相关的肠道微生物群特征的显著变异性可能掩盖了这种关系。然而，老年人尿路感染风险增加独立于微生物群介导机制这一可能性也不能排除。
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