Urinary Fungal Microbiome and Associations With Overactive Bladder, Antibiotics and Therapy Response

OBJECTIVE: To characterize and compare the fungal urinary microbiome ("mycobiome") in healthy women and those with overactive bladder (OAB), and secondarily compare the mycobiome by comorbidities, recent antibiotic exposure, and response to OAB therapy. MATERIAL AND METHODS: DNA was isolated from urine of those with and without OAB and underwent internal transcribed spacer (ITS) sequencing to detect fungi. Alpha- and beta-diversity, and relative abundance of fungal taxa were analyzed and compared by patient characteristics including OAB status. Fungal-bacterial interactions were identified. RESULTS: A total of 152 participants were included and fungi were detected in 98% of samples. The most abundant fungal phyla were Basidiomycota and Ascomycota. The most abundant genera were Malassezia, Candida, and Aspergillus. Candida was more abundant in the urine of individuals without OAB (p = 0.01) and Debaryomyces was more abundant in individuals with OAB (p = 0.02). Beta diversity differed between individuals with and without OAB and by diabetes mellitus status (p < 0.05). Relative abundance of fungal genera differed by OAB phenotype, diabetes mellitus status, antibiotic use, and response to OAB treatment (p < 0.05). Fungal-bacterial interaction networks demonstrated a central role of fungi in the interkingdom community structure. CONCLUSIONS: The study provides new insights into the fungal composition of urine in the physiological state as well as in the context of OAB. Fungi appear to play a central role in interkingdom fungal-bacterial interaction networks. The findings pave the way for future investigations to assess the role of urinary fungi in urologic health and disease, and its modulation to augment therapy.