00:00 – it’s been quite startling to us that swap samples show huge levels of um El
00:06 – lactobacillus way more than anything we see in healthy controls welcome back to our Liv UTI free Channel my name is
00:12 – Melissa and this is part two of our interview with Nick Parkinson a scientific director and researcher in
00:17 – the field of recurrent and chronic UTI in part one we discussed the urinary and vaginal microbiomes and the impact of
00:23 – probiotics here in part two we’ll discuss how to interpret urine and vaginal swab test results if you like
00:29 – these video think they’re important and want to support what we do be sure to hit subscribe and tick the Bell so you’ll be notified of our future videos
00:36 – thanks again for joining us on this journey to making change in women’s
00:42 – [Music]
00:50 – health we get a lot of questions because of the limitations of culture people assume that many things have been missed
00:56 – historically have you found any organisms in your research that are unusual that you wouldn’t have
01:01 – anticipated finding in the vaginal microbiome or the bladder yes we uh we
01:07 – we’re very surprised to find quite so many um high level bifid bacteria in our samples and I think that they uh we in
01:15 – our opinion certainly represent an emergent U UTI pathogen um but it’s
01:21 – going to take a lot more research before that will become accepted uh but the
01:26 – other um other instances where we found bacteria that we weren’t really expecting we found um in one sample
01:34 – lacti planty pillus uh which we weren’t expecting at all um plantarum was the
01:40 – exact species and we’d never come across this before and it was present in a urine
01:45 – sample in millions of cells per Mill which is very very high uh and we
01:51 – immediately did what any research will do and reached for Google instantly and
01:57 – found that this bacteria is only really known to exist in root nodules for from
02:02 – specific uh plants and we were sat scratching our heads for a long time to work out why on Earth this would be in
02:09 – very high levels in in in a bladder and it was also present in the vaginal swap sample as well and we were completely
02:16 – perplexed until uh we started to find out that uh canist had actually produced
02:22 – a probiotic uh canis Flor which used um a variety of different lactobacilli but
02:28 – this one specifically was the the most prevalent part of that product right and
02:33 – uh we were quite excited because it meant that without any prior knowledge we were able to suddenly find out that
02:39 – this not only could tell the person what’s in their bladder but we could also predict what Whattreatments they’
02:45 – used and what particular probiotic they’d use so that then sent us on a quite an exciting Chase to start
02:51 – ordering in as many probiotics as we could find and to run them through our system to try and get an awareness of
02:57 – what we might find and to be able to predict what people had been using um
03:03 – which again is an entirely different field to what we’re trying to achieve but it’s also very interesting because
03:09 – there were so many claims about probiotics uh that we were suddenly able
03:15 – to answer so firstly what was in the probotics was it really what was on the
03:20 – back of the packet with were the levels similar to what was being claimed um and
03:27 – we found that for the large part they were but uh we expanded out to not just probiotics but to um fermented food
03:33 – stuffs as well so uh we went to um all kinds of different things um but uh
03:41 – kefir I remember one of one of the products uh that claimed to be uh fermented um and contained kefir and
03:48 – probiotics and that we literally found to just be water absolutely nothing in there at all which we found quite
03:55 – scandalous um but uh we also were able to track people who were active taking
04:00 – these products and um we even started uh doing stool samples with our technique
04:06 – and showed that we could very readily find that people who were eating these things taking them orally we could find
04:12 – all of the probiotics appear in the store samples but quite often when they
04:18 – stopped taking the probiotics uh they disappeared quite quickly with the probiotics have you found them also in
04:25 – the vaginal microbiome or the sample we have and we find uh especially if people are using probiotics which is designed
04:30 – as a pesy uh obviously those colon seem to colonize a lot more okay um we
04:37 – haven’t done very in-depth studies but certainly with some people we have found
04:42 – uh a probiotic species still present at fairly robust numbers in vaginal samples
04:47 – many weeks after they’ve finished taking the pessaries um but it seems to be very much an individual situations uh in some
04:55 – people they they seem to colonize quite readily in others uh not at all um and so uh I think that that whole
05:03 – field of research is is is wide open and it’s this kind of tool that will allow
05:08 – it to to really take off um but I’m not necessarily sure it will will get the backing of a lot of probiotic
05:15 – manufacturers do you think it’s possible that some probiotics work to prevent it while someone’s using it because it
05:21 – prevents growth of other organisms rather than colonizing itself yeah that’s absolutely possible I
05:28 – think um we haven’t as I say done an exhaustive study but uh where we see um
05:35 – higher rates of colonization it tends to be in women who’ve been on a lot of antibiotics for a long time now again we
05:41 – might be looking at a skewed population because those tend to be people who are very aware of the fact that they’ve decimated their uh vaginal and
05:48 – urinary microbiomes and so they’re doing something to try to repair that damage
05:53 – um but we find that where there are uh already endemic species which are fairly
05:59 – healthy you don’t tend to see colonization from the probiotics quite so much and that’s
06:04 – okay possibly that there’s already competition for them um but it’s very very hard to know whether there might be
06:11 – something to do with the genetics of the host that’s at play as well right there are so many different factors that could
06:16 – be these these are just observations made on very small numbers but yeah we do see probiotics colonizing uh in some
06:24 – people over time and we even see them spreading to um to the to to the bladder as well in uh serious numbers for some
06:31 – people and not at all in others yeah so that raises two questions you mentioned the long-term antibiotic protocols have
06:37 – you done any Research into how that changes the microbiome over time uh no
06:42 – uh as I say we love research uh and we we’d love to do more of it um but with
06:48 – there’s only a few of us here there’s only five of us that work here and with with at the moment uh we’ve got lots of
06:54 – ideas as to what we want to do but our primary focus at the moment is on our Comm commercial service and making sure
07:01 – that it is providing the tool that uh people who have been um left invisible
07:07 – and suffering for so many years really need uh we recognize that actually the
07:12 – technology that underpins all of our testing can be applied to so many other things and actually we’ve got plans
07:18 – eventually to to get into those but we’re having to be quite um quite
07:23 – disciplined at the moment and that also means with our research as well uh we
07:29 – are uh actively collaborating with uh global leaders in Euro biome research
07:36 – and we’ve all we’ve got a paper that’s coming out at the moment you can get um preprints online which describes our
07:41 – technique and the application to to a healthy biome um already uh and then
07:47 – we’ve got plans for uh we’ve got a collaboration um looking at ecoli and
07:52 – the comparison of uh culture versus our technique on um people who have
08:00 – recurrent ecoli and uh relapsed ecoli infections and then we’ve also got uh a
08:06 – third paper that’s currently um in process where we’re we’re actually um publishing some of our early data on
08:13 – what symptomatic patients look like and going back to some of your questions as to what bacteria are we seeing that
08:19 – other people aren’t right and what is the prevalence of the bacteria that everyone knows about uh and and and how
08:25 – might that be um useful to the community yeah we can some of those links to the video description if they’re available
08:32 – when we publish this there’s one more question about probiotics and good bacteria is it possible that overgrowth
08:38 – of good bacteria could cause symptoms um I we think it’s we think it
08:44 – is possible um we’re not the first to think this by in stretch of the imagination but uh I think the more we
08:51 – research um and the more samples we get in from people who have got very chronic symptoms uh the more we realize that the
08:59 – whole field is very nuanced uh and probably more nuanced than anyone’s really given it credit for at one end of
09:05 – the spectrum we’re going to have people who are suffering from from very obvious infection uh from uropathogens or even
09:11 – from obvious infection by uh bacteria that are not currently deemed to be uropathogens but may in future be
09:18 – accepted as uropathogens but at the other end of the spectrum you you see a lot of people um whose test seems to
09:25 – just reveal uh bacteria that are accepted as being part of the normal healthy Flora of either a vagina or um
09:33 – of of urine so the Nuance really is not just in detecting the species it’s
09:39 – determining the levels and whether there’s something aberant about the levels and the relative ratios that you see and we really do see that uh and
09:47 – it’s been quite startling to us that uh especially in the vaginal swab samples
09:52 – for example we see a lot of patients that come to us or sry donors customers that come to us and swab samples show
10:01 – huge levels of um a lactobacillus and more often than not it’s lactobacillus Cris bartus is the one that we see way
10:09 – more than anything we see in healthy controls now this is a species that’s known to be beneficial it’s uh it it
10:17 – sits in the vaginal tract and it happily excretes uh acid and reduces the pH of
10:22 – the vagina so that it actually acts as a physical barrier to a lot of other bacteria to come in and grow which is a
10:28 – great thing uh and there even probiotics that you can buy now uh specifically for uh vaginal seeding of lactobacillus
10:35 – Chris bartus but we very quickly found that there are a lot of people where the lactobacillus crisart levels
10:42 – are so massive that it’s actually outco competed all other species there’s not
10:48 – another species in there which is very unusual situation to see we don’t see that generally in healthy controls M uh
10:54 – there’s normally a mix of a happy community of different lacto bili or maybe some Garden in there but more
11:00 – often than not uh it’s fairly well matched now we realized about two or
11:06 – three years ago that there is actually a condition which is semi- recognized by some gynecologists called cytolytic
11:13 – vaginosis which is characterized by an overgrowth of lactobacillus right and
11:18 – it’s thought that the overgrowth produces uh way too much acid which uh in the long term actually um will
11:25 – ulcerate the lining of the vagina and it’ll lead to uh dischar pain uh irritation
11:32 – inflammation uh lots of horrible symptoms um unfortunately there’s no
11:37 – real known cure for it there are some ways to alleviate symptoms by washing the vagina regularly with a sits bath or
11:44 – uh trying to use pessaries that might um try to rebalance the ph slightly but
11:50 – we’re seeing this in a lot of people who come to us and uh it’s very obvious that
11:57 – this is a real phenomenon a lot of gynecologists are still struggling to get their heads around whether this is or not but we definitely see it and
12:05 – intriguingly we also see it uh to a certain extent in the uru tract as well
12:10 – okay where uh it hasn’t been recognized and it hasn’t really been discussed previously and we think that there might
12:17 – be a correlate of cytic vaginosis that might happen in the bladder um and
12:23 – certainly we see people who have incredibly high levels of Chris barus in
12:29 – bladder and who under um cystoscopy have shown gross amounts of uh of ulceration
12:36 – of the bladder lining um and also very low ph urines and so it’s we we’re
12:43 – speculating heavily that this is actually an unrecognized condition at the moment um but there’s a lot of
12:49 – research that needs to be done to understand what causes it uh and until
12:54 – we know what causes it uh we we won’t know um how how to correct it um and
13:00 – before any of that we need to know whether it’s actually linked to the symptoms at all or whether this is a complete red herring so there’s a lot to
13:07 – do but certainly the tool that we’produced is starting to to to reveal
13:12 – some some really interesting things that have not been reported before yeah it’s a very interesting area of research I
13:18 – think it may apply to many people based on what we’ve seen from our community and going back to what I’ve said before
13:25 – I think we’re seeing the almost the worst of the worst cases at the moment because we’re such a new technology and
13:31 – and we we’re expensive by our own admission we are expensive we we’re a not for-profit company um we’re
13:37 – self-funded but we we can’t we can’t offer this out as a free test as much as
13:42 – we’d ideally like to um we have to cover our costs and it’s very expensive technology and so we try wherever
13:49 – possible to pin our costs to other Advanced Technologies that are available
13:55 – such as the 6dn srna based Technologies goal eventually is to try to get our
14:01 – technology taken on board by the NHS but that’s a long-term goal and there is a
14:07 – lot of bureaucracy that we have to get through before we get to that um but we would love to see our technique being
14:13 – made available to anyone who needs it uh at any time for free but unfortunately
14:20 – we’re not at that stage yet so we’re we’re we’re left with the people who are so desperate to know what’s going on
14:25 – with them that they’re able they’re they’re willing to pay the that we we charge and so we do see I
14:31 – think a very Niche set of of of sufferers um yeah and within that we do
14:38 – see uh yeah this this phenomenon occurring more regularly than we would
14:43 – have expected by chance alone I think okay we received a couple of questions from people who use catheters about
14:49 – whether the testing that you offer is appropriate for catheter users um I don’t see why not uh we
14:57 – haven’t tried it to be completely honest uh we have had a very interesting case
15:02 – study uh of um someone in a nursing home where there’s been a su suspicion of a
15:09 – long-term UTI uh for for years and the nursing home staff used a um an inconsonant pad
15:17 – which was designed to allow you to recover the urine sample we were slightly dubious about using this to
15:22 – start with we thought that the prospect of contaminants uh were were quite high
15:28 – but because was such a Frank infection we saw it very very quickly and so uh
15:33 – that’s worked beautifully and we think that if that that that can work I don’t un I don’t really see a reason why a
15:40 – catheter-based sample wouldn’t uh provide fairly robust results and again
15:46 – it all depends on what the results look like if it’s eoline it’s through the roof I don’t think anyone’s really going
15:51 – to argue that that’s not causing the UTI so we were speaking about healthy controls do you have any research that
15:59 – shows what a healthy control should look like in terms of the vaginal microbiome so interestingly the healthy
16:05 – controls uh microbiome is fairly well researched and defined and this has come from previous research on 16srna work
16:13 – and um researchers tend to classify the healthy vaginal microbiome at least into
16:19 – one of five different classes uh and they’re called Community State types and
16:25 – um most vaginal communities will be a mixture of different bacteria uh largely different types of
16:32 – lactobacillus that are in there quite often you’ll get gardenella in there corny bacteria lots of other different
16:37 – things but mostly it’s going to be lactobacillus and the different Community State types um they’re
16:44 – dominated by different types of lactobacillus so in this table that we’re showing uh you should be able to
16:50 – see that each column um is a different set of results from an actual patient
16:56 – that we’ve looked at a healthy control um so for example the First Column uh
17:02 – which is under the Community State type one shows a variety of different species of the present at different levels so
17:08 – each species is given on a different row um but in Community State type one it’s
17:14 – uh dominated by lacto crispatus which is how you define Community State type one
17:19 – Community State type two which is the second column an example of uh is where the uh microbiome is dominated by
17:27 – lactobacillus gaseri mhm um type three is where it’s dominated by lactobacillus
17:32 – iners and type five which is more rare we don’t tend to see that that much is
17:38 – uh lactobacillus gensen the slight Oddity in all of this is type four which
17:44 – is where you see a microbiome which is dominated by gardnerella vaginitis now
17:49 – that is um a slight odity in that we know that high levels of that bacteria
17:56 – can also cause bacterial vaginosis and so it’s unclear at the moment as to whether that’s a genuine Community State
18:03 – type for uh asymptomatic healthy controls or whether they are it’s people who genuinely just have a low-level BV
18:10 – infection but we saw all of these very quickly uh and very clearly with our
18:16 – technique when we started to look at all of our healthy controls which gave us a lot of confidence that what what our
18:21 – tool is telling us actually matches what’s already known um but what’s also
18:28 – interesting is that we spoke earlier about the uh the consistency between the
18:33 – microbiomes of the vagina and the and and the and urine and the bladder we see
18:38 – that the same Community State types that are present in the vaginal sample are very often the same ones that are in
18:45 – urine and it’s uh it’s less uh it’s less frequent to talk about urob biomes in
18:52 – terms of CST types but I think actually it’s just as relevant because it seems that that’s where as as most of your
18:59 – Euro biome seems to be driven from your vaginal biome it makes absolute sense that if you’re if you’re carrying
19:04 – Community State type one vaginally it’s probably going to be what you’re going to find in your eurome as well and do
19:11 – you know if these State types apply differently pre and postmenopause uh absolutely so menopause
19:18 – is a really fascinating um fascinating uh well not condition but it’s a
19:23 – fascinating uh time of life where uh the microbiome as you know changes a lot uh
19:30 – and there’s a lot of evidence to suggest that actually prepubescent and postmenopause um the vaginal lining uh
19:38 – is quite different in terms of the hormones it excretes and also physical attributes between that time during
19:45 – sexual activity uh it seems that the vaginal lining actually recruits um it
19:53 – goes some way to almost actively Farm lactobacilli as a protective measure and
19:58 – so it will uh led by hormone levels um it will um start to lay down glycogen
20:05 – and which is a chemical that certain lactobacilli prefer to eat as their foods and their energy source and so um
20:13 – when we get to well when women get to menopause uh and the hormone levels alter uh again um it seems that a lot of
20:21 – the glycogen that’s excreted by the vaginal um epithelia to recruit these uh
20:27 – lactobacilli it it it disappears and as a consequence a lot of postmenopausal women see a real
20:34 – reduction in the levels of lactobacilli that are present uh which can leave them prone to infection uh because it is a
20:40 – very useful defense mechanism when it when it’s when it’s in place um and it also means that uh it can leave
20:48 – prepubescens in a similar situation as well so it’s it’s kind of fascinating but it’s uh again it needs a lot more
20:95 – study and a lot more observation but we really hope that this tool that we’produced is actually going to help
21:00 – clarify and just make the whole picture so much easier to understand that would be great to see so let’s talk about the
21:07 – digital microbiology urine and vaginal swab test results how are the results reported are all organisms found listed
21:14 – or is there a threshold below which an organism will be omitted from the results so so yes and no it’s a a
21:20 – slightly comp complicated picture um we try to uh to publish every single
21:27 – bacteria that we find um but at the same time uh we need to do it in a way that is Meaningful uh so
21:34 – that you know it’s your data people have paid money for this test their customers they want to see every bacteria that’s
21:40 – in there and so that’s exactly what we publish but we don’t want to publish a long tale of organisms that we find at
21:48 – very very low levels and also the lower the level you go the less the confidence
21:53 – you have that it was really in there in the first place and it wasn’t a contaminant and so we do put a threshold
21:59 – in place we actually put two thresholds in place we have like a hard kind of floor level which uh is is set by our um
22:07 – our bioinformatic software and that means that if we don’t recover uh more
22:13 – than a basic amount of DNA fragments for an individual organism we won’t have the confidence to say that it was really in
22:20 – there so for example if we only found one fragment of DNA which matched eoline
22:26 – we would probably say that there’s no real confidence that that was really in there cuz one bit of DNA is not a whole
22:32 – lot yeah we like to see the same organism being matched in lots of
22:37 – different fragments of DNA before we have a lot of confidence that it was really there and so we do have this hard
22:44 – cut off um which can’t be changed uh we can look at underneath it but the customer can’t we then also have like a
22:51 – what we kind of term a soft cut off a threshold where we prefer to only
22:56 – publish results which uh indicate in urine cells uh organisms that are there
23:02 – that over a thousand cells per Mill um that’s still about a hundred times more
23:09 – sensitive than a culture test would be uh for the same organism and it’s
23:14 – incredibly sensitive but we do allow people on the results pages to uh remove
23:19 – that threshold and they can look at anything that’s uh sits in that gray area between a, cells per mil and our uh
23:27 – hard threshold that we we don’t allow people to go below because simp simply we think it’s misleading and we don’t
23:34 – have confidence that anything at that level is real and so we don’t want to tell people that they might have
23:39 – something that they really don’t and so confidence levels are very important and we thought long and hard about them the
23:45 – confidence levels in the vaginal samples are different just because we get so much more material back and so we
23:50 – generally set those at about 10,000 cells per swab uh that sounds like a lot
23:57 – as a lower threshold but most of the time we’ll see say for example in a healthy individual we might see
24:03 – crispatus at levels which are in the T if not you know hundreds of millions of
24:08 – cells per per swab so it’s really a very small fraction of what you’d expect to
24:13 – see uh in there that we’re going down to right and if multiple organisms are identified which I assume most of the
24:20 – time they are do the results help determine which of them should be treated first absolutely and we have a a
24:27 – bit of a mantash that uh you know a lot of uh culture-based tests uh that we we
24:32 – see results coming back from and obviously we’re comparing our testing to
24:38 – to culture base all the time uh in in in the NHS system if a culture grows more
24:45 – than one type of organism it’s discarded as being mixed growth our Mantra is that if it doesn’t it should be discarded
24:51 – completely because there should be more than one organism present in virtually every sample and so that really just
24:57 – kind of gives you an idea of how far removed it is from reality um we do see
25:02 – multiple uh organisms in general in a healthy control say a vaginal sample we
25:07 – might see five or six uh strong signals for different species we might see more
25:13 – than that we generally find it in an infection that looks like it might be um an anerobic uh vaginitis for example we
25:21 – see that actually once you get uh what looks to be a Frank infection it almost opens a door on a lot of different organ
25:28 – Ms coming in so we might have long much longer lists and the and the picture becomes more complicated and we’re very
25:35 – aware of the fact that these are long list of organisms that people are not going to really be familiar with yeah
25:40 – and so we try our best to offer them in a way that makes sense so if they are
25:46 – known or suspected uh organisms in pathology either vaginal or urinary pathology then
25:53 – we’ll color code them differently we have the a traffic light system so that if it’s ecola for example it will be
25:58 – shown as red if it’s uh something like a bifido brev it’ll be shown as yellow because it’s suspected but it’s not
26:04 – known okay uh all other organisms that are uh not suspected to cause pathology
26:09 – will be shown in green but then there’ll also be organisms which aren’t normally associated with being in a vagina and
26:16 – there’s no real evidence either way and so we’ll have to uh color those in
26:21 – Gray we also try to provide a little kind of um info card for each one so if
26:26 – you Mouse over each organism that’s in your table uh then you should be able to have a little popup bit of text which
26:32 – will tell us tell you what’s known about that organism in the context of either the vagina or or or the urine um sample
26:40 – now when you’ve got a database full of 4,000 different species that’s a lot of species to start trying to drain Google
26:47 – and trying to work out what might be relevant what might not be so there’s by
26:53 – no means is our database complete uh for information cards but obviously it’s it’s an ongoing process and the ones
26:59 – that are most commonly seen now do have advice advice with them and so it’s
27:05 – advice that’s not just aimed at the customer we’re hoping that the customer will then take these data and show them
27:12 – to a clinician and the clinician is likely to be as bemused by this kind of
27:17 – data as as anybody else and so it’s really uh it’s our way of trying to
27:22 – allow anyone who reads it to make sense of it and to try to work out how that might impact on a diagnostic right and
27:30 – when it comes to diagnosis what is your approach to treatment options and showing what might be most
27:36 – beneficial so we have a tiered approach so um we are constantly doing um
27:43 – in-house testing uh for sensitivity we can’t do that based on our DNA um direct
27:50 – DNA sequencing I think the future will come not too far away where just from
27:55 – the DNA code alone you’ll probably be able to make very good predictions about what the sensitivity is of that
28:00 – particular bacteria but unfortunately the knowledge and the research just isn’t there yet but our tool will be
28:06 – ready and we’ll apply it as soon as it is as it is known but to back up our uh
28:11 – DNA based approach we’re constantly doing culturing in the lab where we’re growing different bacteria from uh
28:17 – samples that come in um and because we know what bacteria we’re looking for we’re able to provide the uh the correct
28:24 – culturing uh requirements for that particular bacteria to get it to grow in the lab we have a very flash piece of
28:30 – equipment called a moldy which allows us to provide an independent confirmation that that really is the bacteria that we were seeing and it’s not just based on
28:36 – the DNA uh predictions and then we we can expose it to lots of different
28:41 – antibiotics and grow it to see uh not only which antibiotics uh seem to kill
28:46 – off that bacteria but also uh what level of that antibiotic it’s required to kill it with the carat that this is in a
28:54 – culture in the lab and not necessarily going to equate brilliantly to what’s
28:59 – happening in a urine in a bladder in the urine or in a the vaginal context but it does give you a guide for which
29:05 – antibiotics probably have no hope in Hell of touching these bacteria and so all that information goes into a
29:11 – database and that is sat sits behind your results so that if you have a
29:17 – bacteria that comes up in your results which is a known uropathogen so what we call a red species so again eoli or
29:24 – falis or Kella or one of those wells-known um bacteria then we will automatically
29:33 – provide uh back antibiotic um results
29:38 – not for your spe particular strain but where in the lab we may have tested 10 or 15 different strains of that bacteria
29:45 – and we know which antibiotic generally is going to be most effective in that context and so that will be published
29:52 – alongside your results right but so that things don’t get too confusing we only
29:58 – give antibiotic suggestions for treatment uh where there is a non
30:13 – neuropathogenic causality is a long and fraud one right and if a patient orders a test do they have access to these
30:19 – recommendations as well or only with a clinicians involvement uh they have access to these recommendations and uh
30:26 – we have also got a a service which will be coming online soon
30:32 – that the way the system works the way it’s been designed we would uh the speed of turnaround so that people can send us
30:39 – a sample we can test it 24 hours later they can tell what they’ve got in their urine hopefully they can then go back to
30:46 – their GP or clinician and they can say right okay I’ve
30:51 – got um Alo scardovia M and the lab says that this is the best antibiotic to get
30:57 – get rid of Alice scardovia can I have it and then the clinician will make a judgment call on that that information
31:03 – and decide whether to prescribe it or not it may well be that our
31:09 – database won’t work for some people then some people may carry individual strains
31:14 – and remember this goes back to what we were talking about about the fact that the strain that you have in your bladder is probably unique to you they might
31:21 – have strains that don’t react in the same way that the strain we’ve tested in our lab we’try find lots and lots and
31:28 – lots of different strains so we get a much broader picture of how that responds as an organism but there’s always going to be the occasion
31:35 – whena there will be an exception to the rule we are trying to start a new um
31:41 – Service uh which will allow people to actually test with us a urine test and
31:48 – if say for example they’ve previously had a urine test with us shows klepel they’ve taken our treatment advice the
31:54 – treatment advice hasn’t worked we will then grow their exact CLI from their urine sample and then we will
32:01 – uh test it with our barrage of 20 to 21 different antibiotics to say what their exact pleps will do but the problem is
32:08 – that process is slow and it will take several weeks and so that’s not what we want to do in the majority of cases for
32:13 – the majority of cases where the generic information is going to be useful people can get the antibiotic advice within 24
32:20 – hours which is what’s most useful and it’s only in these very very small SE section of of of people who for that
32:27 – doesn’t for whom that doesn’t work they can come back and then they can do the slightly more prolonged bespoke testing
32:34 – okay and right now where are your tests available um so we are uh exclusively
32:40 – online so you have to go to digital microb biology.com to order your test uh
32:45 – and you’ll be able to have an account there which will track securely track any test that you’ve had previously and
32:52 – allow you to compare them directly uh it can track your symptoms if you choose to
32:57 – fill out uh a self um registration symptom tracker that we we provide um we
33:05 – uh are able to uh offer postal home testing kits so this is one of the
33:10 – beauties of our system is that you order a kit it’s dispatched same day normally within that the next day it’ll arrive at
33:16 – your home if you’received a urine test kit then you follow the instructions and you take your urine sample it then comes
33:23 – back to the lab for the next day with guaranteed next day delivery on post swap samples are very similar as well uh
33:31 – we started off by offering just a ukb based uh home sampling system but we’ve now in the last month expanded that
33:37 – using uh FedEx Courier Services to a enable us to actually reach out and and and offer this service to 27 different
33:45 – countries across the EU uh the the the time lag between taking the sample and
33:50 – getting it back into the lab slightly longer but we’ve done a lot of testing
33:55 – uh on the preservative that we use us in our samples and we know that actually uh that Journey time doesn’t really affect
34:04 – uh meaningfully the the sample as it comes in and so we’re now very confident that our that the um our EU service is
34:10 – there the EU service does carry a slight premium for the for the postage because we’re using FedEx doorto door but it
34:17 – does cover not just the journey for the kit to get to your house in whichever country you’re in but it also covers the
34:24 – FedEx journey to pick it up from your house and bring it back to our lab with with um guaranteed uh well priority post
34:31 – okay great we can add a link to the video description for anyone that would like to learn more about the testing available and I just wanted to thank you
34:38 – so much for answering all our community questions and for joining me today thank you very much it’s very exciting times
34:45 – and we we hope to be able to serve the community and help people out as much as we genely can we look forward to that
34:52 – thanks so much for watching I hope part two of this interview provided new insights about organism identification
34:57 – and treatment recommendations for UTI if you’d like to learn more about this or related topics be sure to check out our
35:03 – other videos or head over to live U free.com for articles related to this video we’ll be sure to put some links in
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35:15 – videos thanks so much for watching and until next time keep asking questions and pushing for better Solutions