Urinary microbiome and its relationship with urinary tract infections
Keywords:
microbioma urinario, infecciones del tracto urinario, disbiosis, probióticos, urobiomaAbstract
The urinary microbiome plays a central role in the pathophysiology of urinary tract infections, as its balance acts as a natural barrier against colonization by pathogens, and its alterations (dysbiosis) are associated with recurrent infections and increased susceptibility to infection. A qualitative systematic review was conducted of studies published between 2020 and 2025 in PubMed, Scopus, and Web of Science, which evaluated the composition of the urinary microbiome, its changes in the presence of infection, and its clinical implications. Twenty-eight articles met the inclusion criteria. The studies show that the urinary tract harbors complex microbial communities, with a predominance of genera such as Lactobacillus, Corynebacterium, and Streptococcus in healthy subjects, while in patients with recurrent infections, dysbiosis, loss of protective species, and an increase in opportunistic bacteria such as Escherichia coli, Enterococcus, and Klebsiella are observed, along with reduced microbial diversity. Furthermore, a gut-bladder axis is described whereby the gut microbiota can act as a reservoir for uropathogenic strains, promoting urinary colonization and the recurrence of infections. The integration of next-generation sequencing techniques and expanded cultures improves the characterization of the urinary microbiome and allows differentiation between dysbiosis and active infection. In conclusion, the evidence supports the urinary microbiome as a key component in urinary tract infections and suggests new diagnostic and therapeutic strategies aimed at restoring microbial balance, such as the use of probiotics and other ecological approaches, although controlled clinical trials are still needed to validate their efficacy and define their application in medical practice.
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