In recent years it has been described that the urinary tract of women with RUTI is not sterile. In addition, there are deficiencies in the diagnostic means, so the microbiome could assume an interference in the choice of the most appropriate prophylactic treatment. The objective of the study is to know the characteristics of the urinary microbiome in women who use different measures of prophylaxis to prevent RUTI.

Study design: Prospective multi-center study of 1,614 women > 18 years who receive prophylaxis against RUTI within one year. 
Study groups: 
•	GA (n = 444) antibiotic prophylaxis in conventional suppressive regimen (ciprofloxacin, fosfomycin, cotrimoxazole, nitrofurantoin, amoxicillin)
•	GB (n = 732) prophylaxis with polyvalent bacterial vaccine (Uromune®);
•	GC (n = 438) adjuvant measures other than antibiotic or polyvalent bacterial vaccine (pelvic floor biofeedback, oral D-mannose, endovesical instillation of glycosaminoglycan, topical vaginal oestrogen). 
Variables: Age, secondary diagnoses, concomitant treatments, urine cultures for fungi and bacteria. 
Descriptive statistics, Student's T, Fisher's exact test, ANOVA, multivariate analysis, survival analysis using Kaplan Meier. p <0.05 is considered significant.

Mean age: 57.71 years, SD 18.69, median 61, range 18-93. Lower in GB (mean 52.27 years), followed by GA (57.25) and GC (60.57) (p=0.00057).

Secondary diagnoses:
-	Arterial hypertension: GA 31.08%; GB 14.34%; GC 22.83%
-	Arrhythmias: GA 1.35%; GB 0%; GC 0%
-	Diabetes mellitus: GA 9.46%; GB 2.87%; GC 4.11%
-	Dyslipidemia: GA 12.84%; GB 3.69%; GC 7.53%
-	Obesity: GA 8.11%; GB 3.69%; GC 4.11%
-	Depression: GA 10.14%; GB 2.46%; GC 2.74%
-	Insomnia: GA 3.38%; GB 0.82%; GC 0.05%
-	Hyperthyroidism: GA 3.38%; GB 0.41%; GC 0%
-	Hypothyroidism: GA 15.54%; GB 6.56%; 8.22%
-	Musculoskeletal disorders: GA 2.03%; GB 0%; GC 0%.

Before treatment, average time suffering from rUTIs was 5.02 years in the general sample, SD 0.58, median 5.4 years, range 4.4-5.7 years. It was significantly lower in GB (p=0.0001).

Average number of UTIs in the general sample: 4.83 at 3 months and 5.01 at 12 months. Both figures were significantly lower in GB (p=0.0001 for both). More information in Table 1.

Of the total of 1,572 positive urine cultures, the most frequent germ was Escherichia coli (n=1,098), followed by Enterococcus faecalis (n=255), and Klebsiella pneumoniae (n=123). There were more cultures with E. coli in GA than in GB (77.7% vs. 61.89%, p=0.0001) and than in GC (77.7% vs. 68.49%, p=0.0023). There was more Enterococcus faecalis in GB than in GA (18.03% vs. 12.84%, p=0.0217). Candida glabrata was only found in patients in GC (1.37%). More information in Figure 1.

Patients’ general health status may influence the choice of the prophylactic treatment against RUTI, since patients in group A (antibiotic prophylaxis) have more comorbidities. However, it has been already shown the efficacy of Uromune® in elderly patients of both genders (1).
Also, the microorganism causing RTUI is important in the selection of the prophylactic regime proposed to the patient. It is known that D-mannose binds to the tip of type 1 pili and saturates the adhesin FimH, and therefore prevents bacterial adhesion to the urothelium. Although research on type 1 pili focuses mainly on E. coli, it has also been identified in other Enterobacteriae such as K. pneumoniae, S. flexneri, S. typhimurium, S. marcescens, and E. cloacae (2,3). This means that approximately 20% of patients in the sample would not benefit from this treatment.
MV140 favours immunoactive prophylaxis using a suspension of inactivated complete cells of different strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis.

There are differences in the distribution of the urinary microbiome of women with RUTI. This fact may have clinical consequences at the time of indicating a prophylactic protocol. The polybacterial vaccine is indicated in broad-spectrum profiles different from isolated Escherichia coli with a significant reduction in the number of UTI episodes.

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