European Urology Focus · Jan 17, 2025

The Human Urinary Microbiome and Its Potential Role in Urinary Tract Infections

By Saenz CN, Neugent ML, De Nisco NJ

After identifying a urinary microbiota, new insights have emerged into how urinary tract infections (UTIs) develop and recur in women. This review explores factors influencing the urinary microbiome, and its role in UTI susceptibility and recurrence. Age, menopausal status, estrogen, and prior UTIs can impact the urinary microbiome significantly, with estrogen promoting predominance of beneficial Lactobacillus species in women. Study of the urinary microbiome has identified anaerobic bacteria as emerging uropathogens, as well as microbiome species that are markers of recurrent UTI susceptibility. UTIs also impact microbiome functions, including disrupting microbiome scaffolding sites (ie, glycosaminoglycans) and enriching antibiotic resistance genes. A clear link is becoming established between the natural flora of the human urinary tract and UTI susceptibility, which is also impacted by aging and the menopausal transition. Deepening this understanding can lead to the development of a new generation of UTI therapeutic and preventative strategies aimed at modulating the urinary microbiome. PATIENT SUMMARY: A clear link is becoming established between the natural flora of the human urinary tract and urinary tract infection (UTI) susceptibility, which is also impacted by aging and the menopausal transition. Deepening this understanding can lead to the development of a new generation of UTI therapeutic and preventative strategies aimed at modulating the urinary microbiome.

doi.org/10.1016/j.euf.2024.12.005 Open access, accepted manuscript PubMed 39827037 Mechanisms