EURURO Vol. 72 No. 4

651 656

activity can be reduced via both mechanisms. Still, the roles
of different mechanisms involving b 3-ARs in the detrusor,
urothelium, and suburothelium contributing to a reduction
of afferent activity and relief of OAB symptoms remain to be
elucidated.
Conflicts of interest: The author has nothing to disclose.
References
[1]
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[2] Coelho A, Antunes-Lopes T, Gillespie J, Cruz F. Beta-3 adrenergic
receptor is expressed in acetylcholine-containing nerve fibers of the
human urinary bladder: an immunohistochemical study. Neu-
rourol Urodyn. In press. .
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Karl-Erik Anderssona,b
aInstitute for Regenerative Medicine, Wake Forest University School of
Medicine, Winston Salem, NC, USA
b Department of Obstetrics and Gynaecology, Institute of Clinical Medicine,
Aarhus University, Aarhus, Denmark
*Department of Obstetrics and Gynaecology, Institute of Clinical
Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99,
DK 8200 Aarhus N, Denmark.
E-mail address:
# 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Re: Women with Symptoms of a Urinary Tract Infection
but a Negative Urine Culture: PCR-based Quantification
of Escherichia coli Suggests Infection in Most Cases
Heytens S, De Sutter A, Coorevits L, et al
Clin Microbiol Infect. In press.
Experts’ summary:
Heytens et al performed quantitative polymerase chain
reaction (qPCR) for Escherichia coli and Staphylococcus sapro-
phyticus, on top of a standard culture, in urine samples from
220 women with symptoms of urinary tract infection (UTI).
Eighty-six women without symptoms served as controls. In
the symptomatic group, 80.9% of the urine cultures were
positive for any uropathogen and 95.9% were E. coli qPCR-
positive. In the control group, cultures were positive for E. coli
in 10.5% and E. coli qPCR was positive in 11.6%, respectively.
Authors conclude that almost all women with symptoms of
UTI do have an infection with E. coli.
Experts’ comments:
Antibiotic stewardship is the recommended strategy for fight-
ing antimicrobial resistance and the most important single
measure is to reduce the prescription of antibiotics. Medical
societies appeal not to treat asymptomatic bacteriuria
The diagnosis of symptomatic UTI is based on symp-
toms indicative of infection; evidence for the presence of
urinary tract pathogens and evidence for a host reaction.
The critical number of colony forming units is 105
[2_TD$DIFF] CFU/ml
but sterile urine is now regarded as a myth. By means of
PCR and microbiome analyses numerous microorganisms
can be demonstrated where we thought there should be
none .
In a late breaking abstract at the annual meeting of the
American Urological Association 2017, McDonald et al
present the results of a head-to-head comparative phase
2 trial of standard urine culture and sensitivity versus DNA
next generation sequencing testing for UTI. Symptom scores
after treatment were significantly better for those patients
whose treatment was based on DNA results versus
traditional culture studies. All 44 patients had shown
positive results in DNA sequencing tests, while only 13/44
patients had positive urine culture. Authors argue that
bacteria detected with next generation sequencing were
living organisms .
Heytens et al’s and McDonald et al’s papers
demonstrate that with new technologies more patients
with symptoms of UTI will have microorganisms detected
and they will also benefit from antibiotic treatment. If the
results are confirmed in larger trials, colony counts will lose
its role as a criterion for antibiotic treatment and it will
become more difficult for physicians to comply with
antibiotic stewardship recommendations. As a conse-
quence, quantification of the host reaction by white blood
cell counts and interleukinmeasurement may become more
important as treatment criteria. It must be noted that urine
culture remains important for sensitivity testing and as
basis for tailored antibiotic treatment.
Conflicts of interest: The authors have no relevant conflict of interest to
declare.
References
[1] Heytens S, De Sutter A, Coorevits L, et al. Women with symptoms of
a urinary tract infection but a negative urine culture: PCR-based
quantification of Escherichia coli suggests infection in most cases.
Clin Microbiol Infect. In press.
.
[2]
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[3]
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[4]
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[5]
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