Uropathogenic Escherichia coli (UPEC)-Associated Urinary Tract Infections: The Molecular Basis for Challenges to Effective Treatment

• Published in: Microorganisms (Basel) Vol. 11; no. 9; p. 2169
• Main Authors: Whelan, Shane, Lucey, Brigid, Finn, Karen
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28-08-2023; MDPI
• Subjects: Antibiotic resistance; Antibiotics; Antigens; Antimicrobial resistance; Bacteria; Bacterial diseases; Bacterial infections; biofilm formation; Biofilms; Bladder; Drug resistance; E coli; Efflux; Escherichia coli; Genes; Global health; Health services; Immunomodulation; mobile genetic elements; Multidrug resistance; Nanomaterials; Nanotechnology; Older people; Pathogenesis; Pathogens; Patients; Polyuria; Review; Toxins; Urinary tract; Urinary tract diseases; Urinary tract infections; Urogenital system; Urology; uropathogenic E. coli; Virulence; biofilm formation; mobile genetic elements; antibiotic resistance; uropathogenic E. coli
• ISSN: 2076-2607; 2076-2607
• DOI: 10.3390/microorganisms11092169

Urinary tract infections (UTIs) are among the most common bacterial infections, especially among women and older adults, leading to a significant global healthcare cost burden. Uropathogenic
(UPEC) are the most common cause and accounts for the majority of community-acquired UTIs. Infection by UPEC can cause discomfort, polyuria, and fever. More serious clinical consequences can result in urosepsis, kidney damage, and death. UPEC is a highly adaptive pathogen which presents significant treatment challenges rooted in a complex interplay of molecular factors that allow UPEC to evade host defences, persist within the urinary tract, and resist antibiotic therapy. This review discusses these factors, which include the key genes responsible for adhesion, toxin production, and iron acquisition. Additionally, it addresses antibiotic resistance mechanisms, including chromosomal gene mutations, antibiotic deactivating enzymes, drug efflux, and the role of mobile genetic elements in their dissemination. Furthermore, we provide a forward-looking analysis of emerging alternative therapies, such as phage therapy, nano-formulations, and interventions based on nanomaterials, as well as vaccines and strategies for immunomodulation. This review underscores the continued need for research into the molecular basis of pathogenesis and antimicrobial resistance in the treatment of UPEC, as well as the need for clinically guided treatment of UTIs, particularly in light of the rapid spread of multidrug resistance.