{
  "abstract": "**Objectives:** Recurrent urinary tract infection (rUTI) is increasingly complicated by antimicrobial resistance (AMR), yet urinary microbiome dysbiosis and isolate-level resistance-virulence are rarely examined together across different treatment states. In this study, we characterized both within the same sample in rUTI and in healthy controls. **Methods:** In this cross-sectional cohort, mid-stream urine was collected from women with untreated, treated and prophylaxis rUTI and age-matched healthy controls at four centres in South India. Of 80 samples collected, 75 were analysed (26 controls, 20 untreated, 20 treated, 9 prophylaxis) by 16S rRNA V3-V4 sequencing. In addition, 105 culturable isolates from the same samples were identified and tested for antimicrobial susceptibility (VITEK 2) and phenotypic virulence. **Results:** rUTI groups showed approximately half the alpha diversity of controls (median Shannon 1.07-1.18 vs 2.17; Kruskal-Wallis p = 0.041). Community structure differed from controls in every rUTI subgroup (PERMANOVA R-squared = 0.091, p = 0.004; pairwise FDR = 0.008) but not among subgroups. Mean Lactobacillus relative abundance fell from 29.2% in controls to <=13.2% in rUTI groups, while Escherichia-Shigella rose from 7.2% to 25.0-43.0%. Control-referenced dysbiosis z-scores were elevated in all rUTI groups (community distance: FDR <= 0.003; uropathogen: Lactobacillus index: FDR < 0.001 for treated and prophylaxis groups). Among isolates, Escherichia coli predominated (35/105; 16/35, 45.7% multidrug-resistant), followed by Klebsiella spp. (32% multidrug-resistant); carbapenem susceptibility was largely retained, and multidrug-resistant E. coli co-carried more virulence traits. **Conclusions:** rUTI is associated with a stable dysbiotic state that treatment does not restore, combining Lactobacillus loss and uropathogen dominance with a multidrug-resistant culturable reservoir that co-accumulates virulence traits. Reading the community and its isolates together may support microbiome-sparing, resistance-aware management of rUTI.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Food Science and Technology, Pondicherry University"
  ],
  "article_type": "New results",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "name": "S. Kaushik"
    },
    {
      "name": "K. P"
    },
    {
      "name": "S. Pal"
    },
    {
      "name": "N. Nandi"
    },
    {
      "affs": [
        0
      ],
      "name": "G. S. Kiran"
    },
    {
      "name": "S. H. K. Kumar"
    },
    {
      "name": "J. Selvin"
    },
    {
      "name": "V. N. Veettil"
    },
    {
      "name": "S. Devi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dr1vj3k7tmwz6.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.10.758225",
  "fulltext_url": "https://www.biorxiv.org/content/10.64898/2026.10.10.758225v1.full",
  "id": "dr1vj3k7tmwz6",
  "issns": [],
  "landing_url": "https://www.biorxiv.org/content/10.64898/2026.10.10.758225v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "biorxiv",
      "microbiology"
    ],
    [
      "openalex",
      "2713|Urinary Tract Infections Management"
    ]
  ],
  "openalex": "W7221510850",
  "pdf_url": "https://www.biorxiv.org/content/10.64898/2026.10.10.758225v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-10",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dr1vj3k7tmwz6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:27:23Z",
      "native_id": "10.64898/2026.10.10.758225",
      "source": "biorxiv",
      "url": "https://www.biorxiv.org/content/10.64898/2026.10.10.758225v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "biorxiv:microbiology",
      "subfield": "microbiology"
    }
  ],
  "title": "Exploring recurrent urinary tract infection: paired microbiota and culture-based profiling reveals stable dysbiosis and multidrug-resistant, virulence-enriched uropathogens",
  "title_text": "Exploring recurrent urinary tract infection: paired microbiota and culture-based profiling reveals stable dysbiosis and multidrug-resistant, virulence-enriched uropathogens",
  "type": "preprint",
  "updated_at": "2026-10-30T12:27:23Z",
  "url": "https://research.draconitic.com/paper/dr1vj3k7tmwz6",
  "venue": "bioRxiv",
  "versions": []
}