| BackgroundRecent studies in healthy people have discovered the presence of residential urinary microbiome which closely related to human’s health.Changes in urinary micro-ecology have been associated with the occurrence,development and prognosis of various urinary diseases.Accurate diagnosis and timely treatment of complicated Urinary Tract Infections(UTI)play significant protection of renal function in children with congenital anomalies of urinary tracts.The discoveries of urinary microbiome open new therapeutic avenues for complicated UTI.ObjectiveThe aim of our study of urinary microbiome was to compare microbiome profiles in patients with congenital anomalies of urinary tracts and healthy children,to explore the possible association between the changes of urinary tract microbiome and complicated urinary tract infection by comparing the changes of urinary tract microbiome in healthy and diseased children and to provide a new idea for the diagnosis,treatment and prevention of urinary tract infection in children with urinary tract malformations.MethodInpatient admitted to the Department of Urology in the Children’s Hospital of Soochow University from September 2021 to November 2022 were recruited.Urine samples of patients were collected by transurethral catheterization with strict sterile technique before surgical operation or urodynamic studies.A total of 98 children were included in this study and divided into four groups:23 cases of obstructive hydronephrosis,26 cases of primary vesicoureteral reflux,23 cases of neurogenic bladder,26 cases of control group.The distribution and composition of urinary microorganisms were detected by 16S Ribosomal RNA gene(16S rRNA)high-throughput sequencing and bioinformatic analysis.The distribution and composition of urinary tract microorganisms in children with urinary tract malformations were studied to provide evidence support for the diagnosis,treatment and prevention of UTI,and to improve the scientific management of children with urinary tract malformations.Results(1)A total of 98 children were included in this study:23 children with obstructive hydronephrosis(17 males and 6 females,with the age from 2.7 months to 13.25 years old,median 4.5 years);26 children with primary vesicoureteral reflux(15 males and 11 females,with age from 6.1 months to 11.58 years old,median 1.79 year);23 children were neurogenic bladder(11 males and 12 females,with the age from 2 years to 18 years old,median 7.17 years);26 children in control group(24 males and 2 females,with the age from 1.25 years to 6.42 years old,median 3.35 years).(2)Urinary microbiota in children:a diverse distribution and composition of urinary microbiome were found in all children groups.The five most abundant phylum were Proteobacteria,Acidobacteria,Firmicutes,Bacteroidetes and Actinobacteria.The five most abundant genus were Vibrio,Pseudomonas,Ralstonia,Lactobacillus and Prevotella.The dominant bacteria vary significantly among different groups,but the composition of bacteria between groups were similar.(3)Urinary microbiota in healthy children:age affects the richness and diversity of urinary microbiome.With the increase of age,the richness and diversity of urinary tract microorganisms in children increased.The composition and distribution of urinary microbiome in healthy children were different from those in disease state.(4)Urinary microbiome and UTI:In children with primary vesicoureteral reflux,the richness and diversity of urinary tract microbiome were higher in children with preoperative breakthrough urinary tract infection than those without preoperative breakthrough urinary tract infection.The relative abundance of Vibrio and Ralstonia was higher and the relative abundance of Pseudomonas and Prevotella was lower in the group with preoperative breakthrough urinary tract infection than those in control group and the group without preoperative breakthrough urinary tract infection.In obstructive hydronephrosis,the results of preoperative urinary microbiota analysis suggested that the diversity of urinary microbiome was higher in the postoperative re-infection group than that in the group without postoperative infection.The relative abundance of Pseudomonas was lower in the postoperative recurrent UTI group.(5)Urinary microbiome in children with neurogenic bladder:urinary microbiomes changed with different bladder status.The richness and diversity of urinary microbiomes were higher in patients with irregular bladder morphology than those in patients with regular bladder morphology.There were differences in the relative abundance of microbiome between the two groups and the control group.The relative abundance of genus Vibrio and Ralstonia was higher in the group with irregular bladder morphology than that in the control group and the group with regular bladder morphology.The relative abundance of Pseudomonas and Prevotella was lower in the group with irregular bladder morphology.ConclusionsOur results confirmed that there were microbiome colonizing in the urinary tract in children with different ages,genders and physiological status.The composition and distribution of urinary microbiome differs in children by age.In children with urinary tract malformations,the richness and diversity of urinary tract microbiome will increase before UTI.Children have an increased risk of UTI in those who had the dominant bacteria genera of Vibrio and Ralstonia.In children with neurogenic bladder,urinary microbiome changes with bladder morphology status. |
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