Identiﬁcation of Burkholderia fungorum in the urine of an individual with spinal cord injury and augmentation cystoplasty using 16S sequencing: copathogen or innocent bystander?

Spinal Cord Series and Cases, 2018 · DOI: https://doi.org/10.1038/s41394-018-0115-2 · Published: August 1, 2018

Spinal Cord Injury Immunology Gastroenterology

Simple Explanation

The study investigates the urinary microbiome of a 55-year-old male with neuropathic bladder (NB) secondary to spinal cord injury (SCI) and augmentation cystoplasty. Urine samples were collected over eight months during asymptomatic, symptomatic, and post-antibiotic periods and analyzed using 16S ribosomal ribonucleic acid (rRNA) sequencing. The case report highlights the presence of Burkholderia fungorum, a bacterium, in the patient's urine, questioning its role as a copathogen or an innocent bystander in urinary tract infections.

Study Duration

8 Months

Participants

One 55-year-old male with neuropathic bladder secondary to SCI

Evidence Level

Case Report

Key Findings

1
Burkholderia fungorum was present in three samples during both asymptomatic and symptomatic periods, identified by 16S rRNA sequencing but not by traditional cultivation methods.
2
The patient's urine microbiome, regardless of symptoms, was largely composed of pathogenic or potentially pathogenic bacteria, with a notable absence of Lactobacillus species.
3
Urinalysis findings of ≥5 white blood cells (WBC) and ≥2+ leukocyte esterase (LE) were associated with urinary symptoms in this individual.

Research Summary

This case report describes changes in urine inﬂammatory biomarkers and the urine microbiome over an 8-month period in a patient with NB with augmentation cystoplasty secondary to SCI. The ﬁnding of potentially pathogenic bacteria identiﬁed by sequencing but not cultivation, suggests a need for greater understanding of the relationships amongst bacterial species in the bacteriuric neuropathic bladder. This case supports our previous work that a healthy urine microbiome exists in the absence of urinary symptoms, and in this individual with NB with augmenta- tion cystoplasty due to SCI, the healthy urine microbiome is represented largely by pathogenic or potentially pathogenic bacterial species.

Practical Implications

Diagnostic Improvement

Monitoring changes in urine inflammatory biomarkers in conjunction with symptoms may be valuable in differentiating UTI from ABU.

Targeted Treatment Strategies

Understanding bacterial inter-relationships and functions may improve diagnosis and targeted treatment of UTIs in SCI patients.

Future Research Directions

Further examination of the absence of Lactobacillus in the urine microbiome of individuals with NB and SCI is warranted.

Study Limitations

1
Single case approach
2
Lack of ability to generalize microbiome ﬁndings as the patient had augmentation cystoplasty
3
Lack of information on antimicrobials taken during the study period

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