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Abstract：
Electrofulguration (EF) of areas of chronic cystitis in women with antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) can result in improvement of their urinary tract infections (UTIs). We compared urine culture (UC) findings in patients before and after EF, as well as how they vary with cystitis stage at the time of EF, to evaluate for persistent species. After obtaining institutional review board approval, we retrospectively reviewed a prospectively maintained database of EF patients for those with positive UC findings in the 3-6 months preceding EF. Patient pre-EF UC was then compared with first positive UC after EF prompted by a new symptomatic UTI episode, with the hypothesis that the same species will be identified before and after EF. Exclusion criteria included UC from outside institution, neurogenic bladder, and need for catheterization. Ninety-nine women with pre- or post-EF UC-recorded organisms met the study criteria. The median age was 65 years (interquartile range 64-74), with a median time to first positive culture following fulguration of 9.7 months. For 26 patients with positive cultures both pre- and post-EF, the same organism was present in both cultures in 73% of the patients, with predominantly Escherichia coli. EF was effective at reducing the rate of UTIs in this population. For women undergoing EF for antibiotic-recalcitrant RUTIs and associated chronic cystitis lesions, 73% of those with a UC obtained at the time of a first symptomatic recurrent UTI episode post-EF expressed the same organism as before EF. Further study is needed to better understand the evolution of the microbiome post-EF.IMPORTANCEAmong women who experience a recurrent urinary tract infection after a fulguration procedure on areas of chronic cystitis in their bladder, there are no data available on whether the bacterial species found in urine cultures are the same or different from those present before fulguration. By removing the inflamed surface layer of cystitis during fulguration, it is possible that the procedure unmasks deep-seated bacteria. The bacterial kingdom in the bladder wall of these chronically infected women may be different from what is expressed sporadically in urine cultures. Confirming prior studies, we found that fulguration in women with antibiotic-recalcitrant recurrent urinary tract infections and cystitis lesions was effective at reducing the rate of urinary tract infections. At the time of a first symptomatic recurrent UTI episode post-fulguration, 73% expressed the same organism in urine culture as before fulguration. Further study is needed to better understand the evolution of the microbiome post-EF. This article evaluates persistent infections after electrofulguration of areas with chronic cystitis in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Pre-fulguration urine cultures were compared with the first positive urine culture prompted by a new symptomatic UTI episode after electrofulguration, with the hypothesis that the same species will be identified before and after the fulguration procedure. Electrofulguration was effective at reducing the rate of UTIs in this population. However, 73% of those with a urine culture obtained at the time of a first symptomatic recurrent UTI episode post-electrofulguration expressed the same organism (predominantly Escherichia coli) as before the fulguration procedure. Further study is needed to better understand the evolution of the microbiome after electrofulguration.
摘要：
患有抗生素顽固性复发性尿路感染（RUTIs）的女性的慢性膀胱炎区域的电灼（EF）可导致其尿路感染（UTI）的改善。我们比较了EF前后患者的尿培养（UC）结果，以及它们在EF时如何随膀胱炎阶段而变化，评估持久性物种。在获得机构审查委员会批准后，我们回顾性地回顾了一个前瞻性维护的EF患者数据库,这些患者在EF前3~6个月内UC检查结果为阳性.然后将EF前UC患者与由新的症状性UTI发作提示的EF后的首次阳性UC患者进行比较。假设在EF之前和之后将识别相同的物种。排除标准包括来自外部机构的UC，神经源性膀胱，需要导管插入。99名具有EF前或后UC记录生物体的女性符合研究标准。中位年龄为65岁（四分位距64-74），电灼后首次阳性培养的中位时间为9.7个月。对于EF前后培养阳性的26例患者，73%的患者在两种培养物中都存在相同的生物，主要是大肠杆菌。EF可有效降低该人群中UTI的发生率。对于因抗生素顽固性RUTI和相关慢性膀胱炎病变而接受EF治疗的女性，在EF后首次有症状的复发性UTI发作时获得的UC患者中，有73％表达与EF前相同的生物体。需要进一步研究以更好地了解EF后微生物组的演变。重要性在膀胱慢性膀胱炎区域电灼手术后经历复发性尿路感染的女性中，没有关于尿液培养物中发现的细菌种类与电灼前存在的细菌种类相同或不同的数据。通过在电灼过程中去除膀胱炎发炎的表面层，该程序有可能揭开深层细菌的面纱。这些慢性感染妇女的膀胱壁中的细菌王国可能与尿液培养中零星表达的细菌王国不同。确认先前的研究，我们发现,在患有抗生素难治性复发性尿路感染和膀胱炎病变的女性中,电灼术可有效降低尿路感染的发生率.在第一次有症状的复发性尿路感染发作时，73%的人在尿培养物中表达与电灼前相同的生物。需要进一步研究以更好地了解EF后微生物组的演变。本文评估了患有抗生素顽固性复发性尿路感染的绝经后妇女慢性膀胱炎区域电灼后的持续感染。将电灼烧前尿培养物与电灼烧后新的症状性UTI发作提示的首次阳性尿培养物进行比较。假设相同的物种将在充分程序之前和之后被识别。电凝能有效降低该人群中UTI的发生率。然而,在第一次有症状的复发性UTI发作时获得的尿液培养物中，有73％的人表达了与电灼程序之前相同的生物体（主要是大肠杆菌）。需要进一步的研究来更好地了解电灼后微生物组的演变。
