Abstract
BackgroundAge is a significant risk factor for recurrent urinary tract (rUTI) infections, but the clinical picture is often confused in older patients who also present with asymptomatic bacteriuria (ASB). Yet, how bacteriuria establishes in such patients and the factors underpinning and/or driving symptomatic UTI episodes are still not understood. To explore this further a pilot study was completed in which 30 male and female community based older patients (mean age 75y) presenting clinically with ASB / rUTIs and 15 control volunteers (72y) were recruited and monitored for up to 6 months. During this period symptomatic UTI episodes were recorded and urines collected for urinary cytokine and uropathogenic Escherichia coli (UPEC) analyses.ResultsEighty-six per cent of patients carried E. coli (102 ≥ 105 CFU/ml urine) at some point throughout the study and molecular typing identified 26 different E. coli strains in total. Analyses of urine samples for ten different cytokines identified substantial patient variability. However, when examined longitudinally the pro-inflammatory markers, IL-1 and IL-8, and the anti-inflammatory markers, IL-5 and IL-10, were significantly different in the patient urines compared to those of the controls (P < 0.0001). Furthermore, analysing the cytokine data of the rUTI susceptible cohort in relation to E. coli carriage, showed the mean IL-10 concentration to be significantly elevated (P = 0.04), in patients displaying E. coli numbers ≥105 CFU/ml.ConclusionsThese pilot study data suggest that bacteriuria, characteristic of older rUTI patients, is associated with an immune homeostasis in the urinary tract involving the synthesis and activities of the pro and anti-inflammatory cytokines IL-1, IL-5, IL-8 and IL-10. Data also suggests a role for IL-10 in regulating bacterial persistence.
Highlights
Age is a significant risk factor for recurrent urinary tract infections, but the clinical picture is often confused in older patients who present with asymptomatic bacteriuria (ASB)
Drage et al Immunity & Ageing (2019) 16:16 patients who present with significant bacteriuria, but without the symptoms or other adverse effects associated with an Urinary tract infections (UTI) [2]
Asymptomatic bacteriuria (ASB) and UTIs are common in older people, yet non-specific symptoms, often compounded by cognitive problems and the lack of good diagnostic tools to discriminate between the two conditions, can compromise the clinical management of such patients [18]
Summary
Age is a significant risk factor for recurrent urinary tract (rUTI) infections, but the clinical picture is often confused in older patients who present with asymptomatic bacteriuria (ASB). How bacteriuria establishes in such patients and the factors underpinning and/or driving symptomatic UTI episodes are still not understood To explore this further a pilot study was completed in which 30 male and female community based older patients (mean age 75y) presenting clinically with ASB / rUTIs and 15 control volunteers (72y) were recruited and monitored for up to 6 months. The clinical dilemma is considerable because leaving a suspected UTI untreated in such patients may allow the infection to progress resulting in pyelonephritis, septicaemia and in some cases death [2, 12], but if treated unnecessarily can predispose individuals to opportunistic infections such as Clostridium difficile antibiotic induced diarrhoea [11] This conundrum illustrates the need for further investigations in older patient groups, focussing on host-microbial interactions during periods of bacteriuria or asymptomatic carriage and infection
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