The microbiome in urinary tract infections in children - an update
Ursula Lemberger1, Fahad Quhal1,2, Andreas Bruchbacher1
1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Insights
Pediatric urinary tract infections (UTIs) involve specific bacteria and distinct childhood bladder microbiomes. Precise identification aids targeted treatment, protecting the microbiome and preventing antibiotic resistance.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Urology
Background:
- Urinary tract infection (UTI) is a common pediatric infection.
- The pediatric urogenital microbiome is under-investigated and differs from adults.
- Current diagnostic methods for UTI have suboptimal performance.
Purpose of the Study:
- To review recent findings on pediatric UTIs and the urogenital microbiome.
- To highlight the importance of precise bacterial identification in pediatric UTIs.
- To discuss improvements in diagnostic and therapeutic approaches for pediatric UTIs.
Main Methods:
- 16S rRNA sequencing for detailed bacterial identification.
- Analysis of the pediatric urogenital microbiome.
- Review of recent diagnostic advancements for UTI.
Main Results:
- Healthy children's bladders have a distinct microbiome.
- UTIs show altered bacterial composition, often with Enterobacterales.
- Urine pH correlates with bacterial species, showing age-related patterns.
- New diagnostic methods improve upon urine cultures and dipstick tests.
Conclusions:
- Precise uropathogen identification is crucial for targeted pediatric UTI treatment.
- Protecting microbiome homeostasis prevents long-term dysbiosis.
- New therapies, including probiotics, are needed due to rising antibiotic resistance.
Purpose Of Review:
Urinary tract infection (UTI) is one of the most common pediatric infections worldwide. Recently introduced 16S rRNA sequencing allows detailed identification of bacteria involved in UTI on a species-based level. The urogenital microbiome in children is scarcely investigated, with underlying conditions differing from adults. Improvement in diagnostic and therapeutic approaches can help to minimize unnecessary antibiotic treatments, thereby protecting the physiological microbiome.
Recent Findings:
Healthy bladders of children display a distinct microbiome than those of adults. UTI is characterized by changes in bacterial composition, with a high prevalence of Enterobacterales. There is a correlation between bacterial species and the pH of the urine, so a characteristic age-related pathogen pattern can be found due to the acidic urine in infants and more alkaline urine in older children. Recently, new methods were proposed to overcome the suboptimal diagnostic performance of urine cultures and urine dipstick test. This allows precise treatment decisions and helps to prevent chronification of UTI, related voiding dysfunctions and renal scaring, systemic abiosis, and the development of antibiotic resistance.
Summary:
Uropathogens involved in UTIs in children should be identified with precision to allow targeted therapeutic decisions. This can also help preventing the destruction of the microbiome homeostasis, which could result in a life-long dysbiosis. New treatment approaches and recolonization with probiotics are necessary due to increasing intrinsic antibiotic resistance of bacteria.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:17Urinary Tract Infection IV: Nursing Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations