Mp46-09 Risk of Urinary Tract Infection After Intradetrusor Botulinum Toxin a Injection in Catheter-Dependent Patients With Neurogenic Bladder With Asymptomatic Bacteriuria

INTRODUCTION AND .08OBJECTIVE:Prior microbial analyses have correlated urinary bacteria (the urinary "microbiota") with urgency urinary incontinence (UUI) severity, implicating several bacterial taxa such as Aerococcus, an emerging uropathogen.We characterized the urinary microbiome of patients with overactive bladder (OAB) to identify microbial profiles with potential prognostic relevance.METHODS: Catheterized urine samples from 74 postmenopausal women were evaluated by 16S next-generation sequencing (NGS) for bacterial community profiling.Unsupervised k means clustering analysis of NGS data identified population subsets with unique microbial profiles.Quantitative PCR detecting Aerococcus spp.validated NGS results, defining a diagnostic threshold for inclusion in the Aerococcus-positive subtype.Chart review collected data on subject symptoms and responses to therapies.RESULTS: NGS profiling of urine (45 UUI and 29 controls) revealed community patterns in urinary microbiota (urotypes) that segregated with the presence and severity of UUI.Severe UUI was seen in three urotypes: two were diverse communities dominated by Corynebacterium or Prevotella (Mixed), while a third exhibited a homogeneous microbiota dominated by Aerococcus.The phenotypes of Mixed UUI subjects did not differ in symptom severity from the Aerococcus group, although the latter had more bladder-specific pain.Mixed UUI subjects exhibited at least partial responses to OAB medications, with good responses to intradetrusor botox or bladder instillations, and rarely required other therapies.The Aerococcus urotype responded poorly to most therapies, e.g.vaginal estrogen, anticholinergics, botox, bladder instillations, or neuromodulation.CONCLUSIONS: UUI patients have urinary microbial profiles distinct from asymptomatic controls.Severe UUI patients with abundant Aerococcus are clinically indistinguishable from the Mixed group, but exhibit different responses to existing treatment modalities.The Aerococcus urotype had particularly poor responses to first-line therapies and may benefit from earlier consideration of more aggressive management.Use of our quantitative PCR threshold testing may be helpful for prognostic classification of UUI patients.