Yulia L. Naboka

The paradigm shift regarding the non-sterility of urine has fundamentally transformed our understanding of the etiology and pathogenesis of infectious and inflammatory diseases of the genitourinary tract. The application of advanced culture techniques, polymerase chain reaction, and sequencing methods has enabled the identification and characterization of the urobiome composition and an assessment of its role in the development of various diseases. Increasing evidence suggests that infection development can be viewed as a dysbiotic process resulting from alterations in urobiome composition. It has been established that a decrease in normal lactoflora is accompanied by an increase in uropathogens. Therefore, standard culture-based diagnostic techniques no longer reflect the true nature of the infectious process. Conventional urine culture, which identifies a single pathogen at ≥10⁵ CFU/mL (≥10² CFU/mL for lower urinary tract infections), detects only one dominant microorganism while excluding anaerobes, intracellular pathogens, and imbalances in commensal flora. Enhanced Quantitative Urine Culture protocols significantly improve the detection of clinically relevant microorganisms and reveal the polymicrobial nature of infections as well as disturbances in the lactoflora ratio. Modern nucleic acid amplification tests (NAAT), including multiplex molecular panels, identify pathogens more rapidly and with higher sensitivity than culture; in complex cases, the detection rate reaches ≥90% compared to approximately 50% for standard culture. Metagenomic approaches—such as 16S rRNA amplicon sequencing and shotgun metagenomics—further expand detection spectra, identifying dozens of previously missed microorganisms and associated antimicrobial resistance genes. Metaproteomics complements microbiological diagnostics by characterizing host immune responses. Urine proteomic profiling reveals neutrophil-derived proteins (e.g., myeloperoxidase, calprotectin) and microbial proteins, forming the basis for protein biomarkers and phenotypic stratification. An optimal multilevel diagnostic strategy should integrate culture-based methods (for antimicrobial susceptibility testing), NAAT and mNGS—metagenomic next-generation sequencing—for sensitive etiologic verification, and metaproteomics for assessment of the host response. Future efforts should focus on the standardization of preanalytical procedures and the definition of clinically meaningful endpoints.

Objective: to study the compositional features of the intestinal microbiome at the level of certain microbial species in the intestine using NGS sequencing of bacterial DNA for the 16S rRNA gene in patients with different metabolic phenotypes of obesity. Materials and methods: ninety-five patients (17 men and 78 women, mean age 50.4±4.3 years) were examined. Two groups were formed: group 1 (n=40) — patients with metabolically healthy obesity (MHO), group 2 (n=55) — patients with metabolically unhealthy obesity (MUHO). The intestinal microbiome was studied using metagenomic analysis. Sequencing of the v3-v4 variable region of the 16S rRNA gene was performed from fecal samples after DNA isolation. Results: statistically significant (pF. prausnitzii in their intestinal microbiomes compared to those with metabolically unhealthy obesity. Conclusions: the intestinal microbiomes of patients with metabolically healthy obesity and those with metabolically unhealthy obesity differed at the species level for certain microbial taxa.

Introduction. Infectious and inflammatory complications (ICs) are a significant, potentially life-threatening condition developing during transurethral resection of the prostate (TURP) with a frequency of 0.5% to 20.0% of cases. Most studies provide data on immediate ICs. However, there are currently no studies in the literature with a comprehensive assessment of late ICs after TURP. Objective. To analyse the significant predictors of ICs for the development of a prognostic model for the risks of developing remote infectious complications TURP. Materials & methods. This single-center retrospective study includes data from 301 patients who underwent monoand bipolar TURP from 2016 to 2023. Inclusion criteria for the study: prostate volume (30–80 cc), no history of urinary tract infections (UTI) at the time of hospitalization and treatment with antibacterial drugs for at least one month before surgery, possible presence of latent UTI before surgery, absence of prostate cancer. The exclusion criterion was non-compliance with the inclusion criteria. The infectious complications assessed included upper and lower urinary tract infections, as well as epididymitis, orchitis and prostatitis, confirmed based on clinical and laboratory data. Results. In the late period, 47 (15.6%) patients developed infectious and inflammatory complications: urethritis developed in 8 cases, epididymoorchitis in 18, acute prostatitis in 9, and cystitis was diagnosed in the remaining 12 cases. Regression analysis revealed three statistically significant predictors: baseline PSA density, dysuria at hospital discharge, and scrotal discomfort / pain during hospitalization. The explained variance in the incidence of late ICs was 37.4%; the area under the curve in ROC analysis was 0.83; 95% CI [0.75; 0.90]. Conclusion. Implementation of the developed predictive model into clinical practice can improve the safety of transurethral surgery for BPH, optimize resource allocation, and improve the effectiveness of clinical outcomes in the treatment of urological infections. The predictive model can be used when discharging a patient from the hospital after TURP.

Objective: to study the features of the content of some types of microorganisms in the colon in obese patients and healthy individuals with normal body weight using metagenomic sequencing. Materials and methods: a total of 265 people (44 men and 221 women, average age 47.1±4.8 years) were examined. Two clinical groups were formed: healthy individuals with normal body weight (n=129) and obese patients (n=136). The composition of the intestinal microbiome was assessed using metagenomic analysis. DNA was isolated from fecal samples and sequencing of the v3-v4 variable region of the 16S rRNA gene was performed. Results: statistically significant (pP. copri was increased in obese patients. and decreased F. prausnitzii, B. adolescentis and B. longum. Conclusions: the obtained results demonstrated certain species differences in the intestinal microbiome in healthy individuals and in obese patients.

ВВЕДЕНИЕ По сравнению с другими локусами человеческого организма, микробиом и микробиота мочи остаются не до конца изученными. Также в настоящее время крайне актуально течение и влияние асимптомной бактериурии на развитие разных осложнений мочевыводящих путей, особенно у беременных. Существует ряд исследований, описывающих микробиоту мочи у беременных, но большая часть из них охватывает III триместр беременности, что не может дать полноценную картину микробиоты мочи и его возможные изменения на протяжении всей беременности. ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить микробиоту свежевыделенной средней порции мочи у беременных в I триместре. МАТЕРИАЛ И МЕТОДЫ Проведено одноцентровое проспективное наблюдательное когортное исследование с последовательным набором 19 женщин. Критерии включения: возраст 20—26 лет, одноплодная первичная беременность ≤12 недель. Образец средней порции мочи собирали с соблюдением гигиенических правил для максимального предотвращения контаминации. Бактериологическое исследование мочи осуществляли путем использования стандартных питательных сред в соответствии с Клиническими рекомендациями по бактериологическому исследованию мочи (2014) и дополнительных для верификации более широкого спектра аэробных и анаэробных микроорганизмов. РЕЗУЛЬТАТЫ Во всех случаях моча беременных и небеременных была нестерильна и содержала различные композиции аэробно-анаэробных микроорганизмов. Всего верифицировано 25 таксонов микроорганизмов: аэробные (АЕ) микроорганизмы были представлены 15 таксонами, анаэробные (АНА) — 10 таксонами. В обеих группах среди АЕ доминировали E. faecalis (68,4 и 47,4% соответственно), Corynebacterium spp. (47,4 и 63,2%) и S. epidermidis (36,8 и 31,6%), а среди АНА — Lactobacillus spp. (89,5 и 84,2%) и Eubacterium spp. (73,7 и 68,4%). Наряду с установленной относительной идентичностью бактериального спектра микробиоты достоверные различия (pPeptococcus spp. (15,8 и 47,4%) и Propionibacterium spp. (5,3 и 31,6%). Однако следует отметить, что у беременных частота верификации Candida spp. была в 3 раза выше, чем у небеременных. ВЫВОДЫ Микробиота мочепузырной мочи беременных I триместра подобна, но не идентична микробиоте молодых здоровых сексуально активных женщин. Отличия достоверны лишь по двум анаэробам. Однако недостоверные отличия касаются как E. coli, так и представителей грампозитивной микробиоты, в частности, некоторых видов кокков и дрожжеподобных грибов рода Candida. Значение отличий еще предстоит изучить.

Objective: to evaluate changes in the skin microbiota of the children with acute urticaria of varying severity. Materials and methods: a total of 94 children aged 3 to 14 years old were examined. Four clinical groups were formed. Group I (n=15) included children with mild acute urticaria, group II (n=32) – with moderate course, group III (n=16) – with severe form, and group IV (n=31) – children of the 1 and 2a health group (control group). All patients underwent a comprehensive clinical and laboratory examination, as well as a qualitative and quantitative assessment of the skin microbiota. The sampling of the material for bacteriological examination was carried out from the area of the middle third of the forearm on the affected area of the skin and on a symmetrical unaffected area in patients with acute urticaria. In the control group, the material was taken from the corresponding area of the forearm skin. Results: in the unaffected area of the skin in patients of group I, the rate of detection of Propionibacterium spp. (pConclusions: the data obtained during the study indicate differences in microbial patterns of the skin depending on the severity of the course of acute urticaria in children.

Introduction. It has been established in an animal model that coagulase-negative staphylococci (Staphylococcus haemolyticus) and anaerobes (Peptococcus niger) cause the development of an acute inflammatory process in the prostate when inoculated with 10³ CFU/ml. At the same time, data have been published indicating the pathogenic potential of these microorganisms on a titer of 10² CFU/ml. But it was confirmed for the model of acute obstructive pyelonephritis. In addition, the characteristics of the formation of the inflammatory response at different times were determined, which require detailed verification and comparative characteristics with those during infection with a causative uropathogen (Escherichia coli).Objective. Based on the results of the experiment, to carry out: 1) an evaluation of the relationship between the dynamics of microbial load and the degree of pathomorphological changes in prostate tissues during infection with various uropathogens in a titer of 10³ CFU/ml; 2) an evaluation of the degree of microbial load and severity of histological changes in prostate tissues on follow-up day 7 with transurethral infection with various uropathogens in a subpathogenic titer of 10² CFU/ml; 3) a fundamental comparative analysis of the indicators of contamination and the severity of inflammatory changes on follow-up day 7 after the inoculation of various uropathogens in titers of 10² and 10³ CFU/ml.Materials and methods. The animal model was performed using the FELASA and ARRIVE guidelines. Lab animals: 20 New Zealand rabbits. Uropathogens: E. coli, S. haemolyticus, and P. niger. Infectious titers: 10^2.3 cfu/ml. Uropathogen inoculation technique: topical transurethral. Randomization: all laboratory animals were divided into 4 groups depending on the uropathogen (3 experimental, 1 control). Follow-up periods: day 1, 3, 7 and 14 for a titer of 10³ CFU/ml, and day 7 for a titer of 10² CFU/ml. At the end of the follow-up, euthanasia and autopsy were performed with the extraction of the urogenital organ complex. Hereafter, biopsies were taken from various parts of the prostate. Cultural and histological studies of prostate tissues were carried out using standard methods. The results were analyzed using Statistica 10.2 (StatSoft Inc., Tulsa, OK, USA) and GraphPad Prism 9 (GraphPad Software Inc., Graphpad Holdings LLC, San Diego, CA, USA) programs through descriptive and nonparametric statistics.Results. Bacterial contamination of prostate tissue was determined in all cases of infection with differences (p < 0.05) in some indicators between the E. coli and P. niger groups at different observation periods, but only in the case of inoculation of the test titer of 10³ CFU/ml. Histological evaluation of prostate tissues after inoculation with 10³ CFU/ml verified the presence of acute destructive changes in the prostate from the follow-up day 1, which were more pronounced in the S. haemolyticus and E. coli groups. However, similar characteristics of the development of the inflammatory process in the form of hyper-eosinophilic infiltration in the early stages and pronounced congestion of the prostatic glands were identified in the S. haemolyticus and P. niger groups. Comparison of trends in dynamic changes of microbial load (rise / decline) and severity of pathological changes (increase / resolution) in prostate tissues in established follow-up periods showed the presence of relative synchronization of trends (from days 1 to 7) in the S. haemolyticus and P. niger groups, and complete synchronization in the E. coli group. When comparing the median microbial load of the prostate on the follow-up day 7, no intergroup (p > 0.05) differences were found both in cases of infection with a titer of 10³ CFU/ml, and when compared with the data on contamination for a test titer of 10² CFU/ml, at the same time observations. At once, when E. coli and S. haemolyticus were infected at a subpathogenic titer of 10² CFU/ml, inflammatory changes were recorded that had a mild diffuse character, in relation to those after inoculation of these pathogens in a titer of 10³ CFU/ml. In turn, P. niger induced the development of low-intensity focal alteration in isolated areas of prostate tissues.Conclusions. Detailed analysis of culture and histological data showed that E. coli, S. haemolyticus and P. niger have significant pathogenic potential at titer of 10³ CFU/ml. In turn, when the titer decreases to 10² CFU/ml, E. coli and S. haemolyticus retain their pathogenic potential, but the severity of the inflammatory reaction is significantly reduced. It was also found that a change in bacterial contamination affects the severity of the inflammatory process in all groups during seven follow-up days at a given test titer.

Objective: to study the microbiota of the vagina, myomatous nodes, their bed in patients with fibroids. Materials and methods: a comprehensive examination of 83 patients aged 26 to 50 years with diagnosed interstitial, interstitial-subserous uterine myoma was carried out. By age, all women are divided into 3 groups. Standard clinical and clinical laboratory studies, colposcopy, microbiological examination of the detachable posterior vaginal fornix, biopsy specimens of myomatous nodes and their bed, as well as morphological examination of biopsy specimens of myomatous nodes and their bed were performed.Results: in the structure of clinical manifestations of uterine fibroids, pain syndrome was the leading one (p0.05). According to the results of a bacteriological study of the detachable posterior vaginal fornix in patients in the 2^nd group, a decrease in the frequency of detection and the number of lactobacilli was revealed compared to the 1^st group, and in women in the 3^rd group, these microorganisms were absent. Among the anaerobic microorganisms in the 1^st and 2^nd groups, Eubacterium spp. dominated, in the 3^rd — Peptostreptococcus spp. In patients of group 3, the frequency of detection of Bacteroides spp. was significantly increased (pConclusions: In women with uterine myoma of different age groups, multidirectional changes in the vaginal microbiota were revealed. In most cases, the myomatous node (92.8%) and its bed (82.3%) are not sterile with the dominance of anaerobic microbiota taxa. Identified significant correlations in the loci «vagina – myomatous node – myomatous node bed» indicate their relationship. The detection of various taxa of microorganisms in the myomatous node and its bed, according to morphological studies, is not associated with the presence of infectious and inflammatory processes in the tissues.

Discussion of risk factors for infectious complications in the general population of patients undergoing transurethral resection of the prostate, antibiotic prophylaxis and therapy has been going on for decades. Up to date, the problem of the manifestation of bacteriuria in clinical infectious processes at various periods, as well as the factors of the introduction of bacterial agents with their further subclinical circulation in the urinary and reproductive systems, seems to be little discussed. The insufficient knowledge of these issues is confirmed by a small number of studies covering mainly electrosurgical mono and bipolar technologies as the most common and studied over a long period of their existence. This review raises the problem of insufficient knowledge of the clinical structure of infections during transurethral surgery, assessment of their risk factors, antibiotic prophylaxis regimens and therapy.

Kogan MI, et al. Investig Clin Urol. 2022 Apr;63:e30. https://doi.org/10.4111/icu.20210451