Characterizing the role of the urobiome in the pathogenesis of recurrent urinary tract infections (rUTIs): a systematic review
Abstract
PURPOSE
Recurrent urinary tract infections (rUTIs) are associated with substantial morbidity, repeated antibiotic exposure, and increasing antimicrobial resistance. Emerging evidence suggests that alterations in the urinary microbiome (urobiome) may contribute to rUTI pathogenesis. This systematic review evaluated the role of the urobiome in the development and recurrence of rUTIs.
METHODS
This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Literature searches were conducted and managed using Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia). Searches included Web of Science, MEDLINE, PubMed, and CINAHL and covered studies published from 2014 through 2026. The final search was conducted on February 1, 2026. The search incorporated terms related to 'urobiome,' 'urinary microbiome,' 'urinary tract infection,' and 'recurrent urinary tract infection.' Searches were restricted to English-language studies and human participants. After deduplication, 213 unique records underwent title and abstract screening, and 62 articles were assessed in full text. 21 studies that directly evaluated recurrent or chronic UTI populations, or reported an rUTI-specific subgroup, were included in the qualitative synthesis. Data extraction included study design, patient population characteristics, definitions of rUTI, urine collection methods, microbiome assessment methodology (including 16S rRNA sequencing and enhanced quantitative…
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