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Introduction: Polymerase chain reaction (PCR) has been shown to be more sensitive in the detection of polymicrobial infections in patients with urinary tract infection (UTI). Bacterial consortia are non-random communities of microbes that may act synergistically to provide growth and survival advantages. We aim to investigate the relationship between bacteria detected by PCR, and the presence of consortia, with clinical findings in patients with symptomatic UTI. Methods: We performed a retrospective analysis of 2493 UTI-symptomatic patients over the age of 60 from 37 geographically disparate urology clinics in the U.S. from July 2018 to February 2019. Clinical findings, including UA dipstick results and UTI symptoms, were recorded. Multiplex PCR (MPCR) was performed to detect 24 different bacterial species in the urine specimens. A cutoff of 10 detections was used to distinguish a bacterial consortium from a random association of bacteria in a polymicrobial specimen. Summary statistics and Kruskal-Wallis test were used to compare the mean numbers of clinical findings across different number of bacterial species within a bacterial consortium. Results: Bacteria were detected in 69% (1710/2493) of patients. Among these, monomicrobial infections were found in 40% (683/1710), and polymicrobial infections were found in 60% (1027/1710). Among the polymicrobial infections, consortia were identified in 433 specimens. Consortia polymicrobial urine specimens had more clinical findings than monomicrobial specimens, 2.84 vs. 2.66, respectively (p=0.022). The more bacteria detected within a consortium, the more clinical findings were reported (p=0.026), Table 1. Among consortia polymicrobial specimens, specimens containing Gram-negative bacteria were associated with a higher number of clinical findings compared to specimens without Gramnegative bacteria, 3.21 vs. 2.52, respectively (p<0.0001). Conclusion: Consortia polymicrobial UTIs were associated with more clinical findings than monomicrobial infections. The number of clinical findings also increased with increasing numbers of bacteria within a consortium. The identification of a consortium within polymicrobial UTIs and the correlation of clinical findings may be important for understanding the treatment of polymicrobial UTIs.


The Annual Winter Meeting of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Virtual, February 25-27, 2021.

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