Does bacterial motility influence the extent of bladder wall involvement in women with recurrent urinary tract infections?

Purpose: Because bacterial motility has been implicated as a potential virulence factor, we compared the motile and nonmotile properties of bacteria isolated from urine cultures in women with recurrent urinary tract infections (RUTI) to test if such motility properties are linked to the extent of bladder wall infection on cystoscopy. Materials and Methods: After IRB approval, a retrospective review of women with antibiotic-recalcitrant symptomatic RUTI (≥3 Urinary tract infections/year) who underwent electrofulguration (EF) for cystitis was conducted. Pre-operative office cystoscopy staged cystitis as stage 1: Trigone (trigonitis), stage 2: stage 1 and bladder base, stage 3: stage 2 and one or both lateral walls, and stage 4: The whole bladder (pancystitis). Positive urine cultures before EF for the type of bacteria (motile vs. non-motile) were compared among stages. Results: From 2006 to 2020, 139 women with RUTI met the study criteria. The median age was 67 with 95% Caucasian. Those with stage 4 cystitis were older (P = 0.0009) and less sexually active (P = 0.038). Patients with a higher stage were associated with a higher number of motile organisms (P = 0.0056), with an increased presence of non-E. Coli motile organisms (P < 0.0001) such as Proteus (P = 0.0024), Pseudomonas (P = 0.0062), Enterobacter (P = 0.020) and Citrobacter (P = 0.0067). Conclusion: The comparison of bacterial motility in women with RUTI at four different stages of bladder surface involvement identified unique characteristics and bacterial strains associated with each stage. RUTI women with higher stages of cystitis had more unique types of motile urinary bacterial strains, possibly suggesting a role in the spread of cystitis beyond the trigone.