Lesion of the Urinary Bladder Microbiome in Neurogenic Dysfunction after Spinal Cord Injury

Abstract

Introduction. Spinal cord injury is one of the most severe forms of neurological damage. It almost always leads to neurogenic bladder dysfunction. This, in turn, leads to a high incidence of recurrent urinary tract infections, which are linked to disturbances in the urobiome. The aim of the study is to summarize current scientific data on bladder microbiome disorders in neurogenic dysfunction after spinal cord injury and to assess the impact of drainage methods, antibiotic therapy, and microbiome-oriented interventions on the course of urinary tract infections. Materials and methods. The study was conducted in a systematic review format in accordance with PRISMA recommendations. Clinical, experimental, and randomized studies were analyzed, followed by qualitative and quantitative data synthesis. It was established that neurogenic dysfunction after spinal cord injury is associated with persistent urobiome dysbiosis, characterized by decreased alpha diversity and a reduction in Lactobacillus spp., with the dominance of Enterobacteriaceae and Pseudomonadaceae. Intermittent self-catheterization is associated with a lower incidence of urinary tract infections and greater microbiome diversity than indwelling catheterization. A high level of antimicrobial resistance was identified, including ESBL-producing strains and carbapenem-resistant Pseudomonas aeruginosa, which sustains a vicious cycle of «dysbiosis – infection – antibiotic therapy». The potential effectiveness of probiotic and immunotropic strategies has been demonstrated, with reductions in infection recurrence rates of 21–32%. The practical value of the results lies in the systematization of data on the disruption of the uromicrobiome, a key element in the pathogenesis of neurogenic dysfunction after spinal cord injury. It is substantiated that microbiome-oriented approaches, early monitoring, and catheterization optimization can significantly improve infection prevention and rehabilitation outcomes. Conclusions. Spinal trauma leads to deep dysbiosis of the uromicrobiome. It is seen as a decrease in the alpha-diversity index and in Lactobacillus spp. Less than 5 % and predominance of E. coli (38–45 %), K. pneumoniae (18–24 %) і P. aeruginosa (12–17 %). Draining of the urinary bladder really influences the microbiological profile. Interruptable catheterization is associated with the lowest frequency of symptomatic urinary tract infections and the highest microbial diversity index. Constant urethral catheterization leads to the formation of stable polymicrobial biofilms and a threefold increase in microbiota abundance. Antimicrobial resistance in neurogenic dysfunction after spinal trauma remains critically high. ESBL-production revealed in 34–58 % of isolates, whereas carbapenem-resistance of P. aeruginosa was found in 15–22 % cases. Тривале та нераціональне використання антибіотиків є незалежним чинником поглиблення дисбіозу (OR = 2,4; 95 % ДІ: 1,7–3,4), підтримуючи порочне коло та вимагаючи принципово нових терапевтичних підходів. Microbiome-oriented correction strategies show clinically important efficacy. Intravesical introduction of L. rhamnosus GG decreases frequency of recurrent urinary infections in 32 % (95 % DІ: 18–46 %), usage of Uro-Vaxom на 21 % (95 % DІ: 8–34 %). Transplantation of fecal microflora has shown promise in animal models. Early microbiological monitoring with molecular typing, application of interruptible self-catheterization, are priorities of preventive medicine in spinal trauma.  Perspectives of future investigations are connected with randomized clinical examinations of fecal microflora transplantation, elaboration of personal uromicrobial profiling on the basis of new generation sequencing.