Bladder microbiome composition prior to urogynecologic surgery may influence women’s postoperative risk of urinary tract infection (UTI), according to a new study.

Notably, depletion of Lactobacillus iners and enrichment of certain uropathogens, especially Enterobacteriaceae and Pseudomonas species, are associated with an elevated risk of post-operative UTI, a team led by Alan J. Wolfe, MD, of the Stritch School of Medicine at Loyola University Chicago in Maywood, Illinois, reported online ahead of print in the International Urogynecology Journal.

In a study of 104 women undergoing a variety of common urogynecologic surgeries, Dr Wolfe and his collaborators examined the association between postoperative UTI with bacteria in preoperative urine specimens obtained by catheter. Investigators collected vaginal swabs, perineal swabs, and catheterized urine specimens immediately prior to surgery.

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In the urine specimens, L. iners was most enriched in women with a negative day-of-surgery (DOS) result and negative postoperative UTI status and most depleted in women with a positive DOS result and positive postoperative UTI status, Dr Wolfe’s team reported.

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

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For most clinicians, absence of UTI-associated symptoms and/or negative urine testing has provided confidence that patients do not have a current UTI. “Yet, clearly, there is an opportunity to reduce the occurrence of postoperative UTI giving our finding that most are related to depletion of Lactobacillus and enrichment of uropathogens in the bladder prior to surgery.”


Thomas-White KJ, Gao X, Lin H, et al. Urinary microbes and postoperative urinary tract infection risk in urogynecologic surgery patients. Int Urogynecol J. 2018; published online ahead of print.