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Challenging UTI Dogma: Applying Basic Bladder Microbiome Research to the Clinic

The old “urine is sterile” dogma is wrong. The lower urinary tract possesses its own resident communities of microbes called the urinary microbiota or urobiome. The standard clinical microbiology urine test does a poor job of detecting the urobiome because it was designed specifically to detect and identify E. coli and other fast-growing uropathogenic bacteria that can grow under ambient conditions. Newer methods, both culture-dependent, and culture-independent have reproducibly identified bacteria that the standard urine culture often misses. Missing organisms can lead to misdiagnosis and mistreatment. We describe the evidence thus far generated, showing that a urobiome exists in the urinary tract and how the research is applied in the clinic for patients experiencing recurrent or persistent UTI’s.

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Health Care Professionals (HCP) including MD’s, DO’s, RN’s, PA’s, RPN’s, and MLS


CME Credits:

1.0 AMA PRA Category 1 Credit(s)™


Learning Objectives:

At the conclusion of this CME activity, participants should be able to:

  1. Compare and contrast basic research studies and observations used to determine if urine contains microbes. 
  2. Describe the impact of various observations for those with a urinary tract infection in the clinic.
  3. Compare and contrast culture-independent methods and culture-dependent methods for detecting microbes from urine.
  4. Compare and contrast bacterial genera detected in patients with lower urinary tract symptoms.
  5. Compare and contrast susceptibility testing methods and describe the discoveries from simultaneously growing all detected bacteria together in the presence of antibiotics when measuring susceptibility.
  6. Describe the clinical implications of applying M-PCR & P-AST testing for patients with UTI.

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Alan J Wolfe, PhD

Professor, Microbiology and Immunology

Director, Loyola Genomics Facility

Co-Director, Loyola Urinary Education and Research Collaborative

Chair, Research Funding Committee


Natalie Luke, PhD

Vice President, Research and Education at Pathnostics


Larry Sirls, MD

Director, Female Pelvic Medicine and Reconstructive Surgery

Professor, Oakland University William Beaumont School of Medicine


Annah Vollstedt, MD

Female Pelvic Medicine and Reconstructive Surgery Fellow



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of PeerPoint Medical Education Institute, LLC and Pathnostics.


The PeerPoint Medical Education Institute, LLC is accredited by the ACCME to provide continuing medical education for physicians. The PeerPoint Medical Education Institute, LLC designates this Live and Enduring for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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  • UTI
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