Bladder wall-embedded bacteria associated with increased risk of recurrence after electrofulguration in women with antibiotic-recalcitrant urinary tract infection.

PURPOSE: Antibiotic-recalcitrant recurrent urinary tract infection (rUTI) is increasingly observed in postmenopausal women. When standard therapies fail, some elect electrofulguration (EF) of areas of chronic cystitis detected on office cystoscopy. EF is thought to remove tissue-resident bacteria within the bladder walls of women with rUTI. We hypothesized that increased bladder wall bacterial burden may be associated with incomplete rUTI resolution following EF.

MATERIALS AND

METHODS

Following IRB approval, bladder biopsies were obtained from 34 consenting menopausal women electing EF for the advanced management of rUTI. 16S rRNA FISH was performed using both universal and Escherichia probes and tissue-resident bacterial load was quantified. Time to UTI relapse after EF was recorded during a six-month follow-up period and the association of bladder wall bacterial burden and clinical covariates with UTI relapse was assessed.

RESULTS

We observed bladder wall-embedded Escherichia in 52% of all participants and in 92% of participants with recent E. coli UTI. Time-to-relapse analysis revealed that women with high bladder wall bacterial burden as detected by the universal probe had a significantly (p=0.035) higher risk of UTI within six months of EF (HR=3.15, 95% CI: 1.09-9.11). Interestingly, bladder wall-resident Escherichia was not significantly associated (p=0.26) with a higher risk of UTI relapse (HR= 2.14, 95% CI: 0.58-7.90).

CONCLUSIONS

We observed that total bladder wall bacterial burden was associated with a 3.1x increased risk of rUTI relapse within six months. Continued analysis of the relationship between bladder-embedded bacteria and rUTI outcomes may provide insight into the management of these challenging patients.