Bacterial Virulence

The development of UTIs in the neurogenic bladder relies on a balance between bacterial virulence and local host factors.1

What do we know about the correlation?

When the ability to locally fight the infection is compromised, uropathogens have easier access to the urinary tract because the natural washout through voiding is not possible.1

Further, upon alteration of the protective flora and changes in the urothelium and bladder wall after injury may let the uropathogens inside the urinary tract more easily adhere to the urothelium and invade the bladder wall.2,3 

These factors may lead to UTIs however, investigation and treatment of these factors are currently on an experimental level.4

Antibiotics and the impact on flora

Note that antibiotics may also interfere with the protective flora.5

A study in 70 women with UTIs showed that the original lactobacillus population had not been restored after treatment in most patients. Rather, uropathogens dominated the flora.5

A similar condition could be relevant for the microbiome in the bladder.4

What happens if the bacterial flora is supported?

The strategy of supporting the host bacterial flora by adding non-pathogenic bacteria have been investigated in a couple of small studies.6,7

Insertion of non-pathogenic bacteria into the bladder showed sufficient colonization rates of the inserted pathogenic bacteria and significant reductions in UTI frequency.8,9

While this approach could be useful, there is still insufficient evidence to support the use of bacterial interference for UTI prevention in daily practice.8,9