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Encrustations on ureteral stents from patients without urinary tract infection reveal distinct urotypes and a low bacterial load

Matthias T Buhmann, Dominik Abt, Oliver Nolte, Thomas R Neu, Sebastian Strempel, Werner Albrich, Patrick Betschart, Valentin Zumstein, Antonia Neels, Katharina Maniura-Weber & Qun Ren

abstract

BACKGROUND
Current knowledge of the urinary tract microbiome is limited to urine analysis and analysis of biofilms formed on Foley catheters. Bacterial biofilms on ureteral stents have rarely been investigated, and no cultivation-independent data are available on the microbiome of the encrustations on the stents.

RESULTS
The typical encrustations of organic and inorganic urine-derived material, including microbial biofilms formed during 3-6 weeks on ureteral stents in patients treated for kidney and ureteral stones, and without reported urinary tract infection at the time of stent insertion, were analysed. Next-generation sequencing of the 16S rRNA gene V3-V4 region revealed presence of different urotypes, distinct bacterial communities. Analysis of bacterial load was performed by combining quantification of 16S rRNA gene copy numbers by qPCR with microscopy and cultivation-dependent analysis methods, which revealed that ureteral stent biofilms mostly contain low numbers of bacteria. Fluorescence microscopy indicates the presence of extracellular DNA. Bacteria identified in biofilms by microscopy had mostly morphogenic similarities to gram-positive bacteria, in few cases to Lactobacillus and Corynebacterium, while sequencing showed many additional bacterial genera. Weddellite crystals were absent in biofilms of patients with Enterobacterales and Corynebacterium-dominated microbiomes.

CONCLUSIONS
This study provides novel insights into the bacterial burden in ureteral stent encrustations and the urinary tract microbiome. Short-term (3-6 weeks) ureteral stenting is associated with a low load of viable and visible bacteria in ureteral stent encrustations, which may be different from long-term stenting. Patients could be classified according to different urotypes, some of which were dominated by potentially pathogenic species. Facultative pathogens however appear to be a common feature in patients without clinically manifested urinary tract infection.

TRIAL REGISTRATION
ClinicalTrials.gov, NCT02845726 . Registered on 30 June 2016-retrospectively registered.
   
citation Buhmann M T, Abt D, Nolte O, Neu T R, Strempel S, Albrich W, Betschart P, Zumstein V, Neels A, Maniura-Weber K, Ren Q. Encrustations on ureteral stents from patients without urinary tract infection reveal distinct urotypes and a low bacterial load. Microbiome 2019; 7:60.
   
type journal paper/review (English)
date of publishing 13-04-2019
journal title Microbiome (7/1)
ISSN electronic 2049-2618
pages 60
PubMed 30981280
DOI 10.1186/s40168-019-0674-x