Disease burden and long-term trends of urinary tract infections: A worldwide report

Global Burden and Trends of UTI in Premenopausal and Postmenopausal Women from 1990 to 2021 and Projections to 2044

Objective

Urinary tract infection (UTI) are an important health issue for women, and this study aimed to assess the different disease burdens in premenopausal and postmenopausal women.

Methods

In this cross-sectional study, secondary analysis was conducted using Global Burden of Disease (GBD) 2021 data to assess the burden of urinary tract infections in women. Our study applied a joinpoint regression model to assess temporal trends and factors, an age-period-cohort (APC) analysis to evaluate age, period, and cohort effects, and a health inequality analysis to examine regional disparities based on the socio-demographic index (SDI), along with a predictive model for future trend forecasting.

Results

From 1990 to 2021, UTI incidence grew faster in premenopausal women (average annual percentage change [AAPC] 0.17 [95% CI 0.15-0.18]) than in postmenopausal women (AAPC 0.04 [95% CI 0.02-0.07]), while mortality increased more for postmenopausal women (AAPC 1.08 [95% CI 0.81-1.36]) than premenopausal women (AAPC 0.45 [95% CI 0.33-0.56]). The COVID-19 pandemic saw a surge in premenopausal UTI incidence (AAPC 0.64 [95% CI 0.62-0.66]). Age, period, and cohort analyses revealed an age-related risk increase in premenopausal women, especially in early birth cohorts. Global health inequalities escalated, with a heavier UTI burden in lower SDI countries. By 2044, projections predict 253.33 million cases in premenopausal and 164.72 million in postmenopausal women, with the biggest increases in the 30-34 and 50-54 age brackets.

Conclusion

The study underscores global UTI burden disparities between pre- and postmenopausal women, worsened by COVID-19, urging future policies to enhance healthcare access, antibiotic stewardship, and high-risk group targeting.

Sublingual MV140 vaccine: a promising noninvasive approach for recurrent urinary tract infections in women

Recurrent urinary tract infections (rUTIs) are a growing global public health problem that has a significant impact on patient morbidity, quality of life, and economic burden. This is compounded by excessive antibiotic use in rUTI prophylaxis, prompting consideration of non-antibiotic prophylactic approaches. There has been increasing understanding of the pathophysiology of rUTIs, where bacteria subvert the host immune response and evade therapeutic strategies. Immuno-prophylaxis with monovalent and polyvalent bacterial preparations to elicit an immune response have come into the spotlight. Increasing understanding of how they achieve this based on innovative mechanistic in vitro and in vivo studies has highlighted the role of enhancing the helper T cell type 1 and diminishing the type 2 response. MV140 (Inmunotek SL, Madrid, Spain) is a quadrivalent bacterial preparation which has contemporary evidence to show good efficacy in improving rUTI clinical parameters, which is acceptable to patients, associated with improvements in quality of life, as well as reduced healthcare resource usage and costs. Importantly, it also appears to be safe and is associated with improved rationalization of antibiotic use. Whilst more rigorous studies are awaited, it shows promise in tackling heterogenous clinical entity.

Characterization of a novel phage vB_EcoP_P64441 and its potential role in controlling uropathogenic Escherichia coli (UPEC) and biofilms formation

Urinary tract infections are one of the most common infectious diseases worldwide, with uropathogenic Escherichia coli (UPEC) being the leading cause. Phage therapy has emerged as a promising alternative due to the increasing prevalence of multidrug resistance UPEC strains. In this study, we isolated and characterized a novel phage, vB_EcoP_P64441, which lysed UPEC, including serogroup O75. The phage can survive from 4 to 50 °C and a pH range of 3-11. The optimal MOI was 1, latent period was 4 min, and burst size was 10 PFU/cell. Whole genome sequencing revealed that it consisted of 42,960 base pairs that encoded 53 CDSs, with no lysogenic, toxin, or tRNA-associated genes detected. vB_EcoP_P64441 was classified as a new species within the family Autographiviridae, subfamily Slopekvirinae. The results of the inhibition experiments showed that vB_EcoP_P64441 had a good suppression effect on the growth of planktonic UPEC. Phage either alone or in combination with cefotaxime was effective in inhibiting biofilm formation of UPEC in vitro. Phage strongly inhibited bacterial growth on disposable rubber catheters and limited biofilm formation within 24 h. Cellular infection experiments showed that pretreatment phage could effectively inhibit UPEC adhesion to bladder epithelial cells with safety and reduce the cellular damage caused by UPEC. Our results suggest that vB_EcoP_P64441 is a novel and effective phage for UPEC inhibition with promising applications.

Prevalence and outcomes of Urinary tract infections caused by Enterobacterales resistant to third-generation cephalosporins in the Emergency Department: results from UTILY cohort, a prospective multicentre study

INTRODUCTION

In accordance with the spread of drug-resistant bacteria worldwide, an increase in the prevalence of Antimicrobial Resistance (AMR) among pathogens causing urinary tract infections (UTIs) has been described globally. The aim of this study was to describe the prevalence and outcome of UTIs caused by third-generation cephalosporin-resistant (3GC-R) Enterobacterales in a prospective cohort of patients admitted to Emergency Department (ED).

MATERIALS AND METHODS

We conducted an observational prospective multicentre study, involving 7 healthcare facilities, enrolling all consecutive adult patients admitted to ED with a microbiologically confirmed diagnosis of UTIs caused by Enterobacterales. The primary outcomes were the prevalence of UTIs caused by 3GC-R Enterobacterales, and 30-day mortality.

RESULTS

During the study period, we included 288 patients with urinary tract infection: 41.7% of subjects were males, median age was 72 years (IQR 56-81). The most frequently isolated pathogen was Escherichia coli (70.5%); 35.9% of all pathogens isolated were non-susceptible to 3GC. At multivariate logistic regression analysis, admission to a hospital (OR 3.31, 95% CI 1.41-7.75, p = 0.006) or a long-term care facility (OR 4.87, 95% CI 1.16-20.36, p = 0.03) in the previous three months was independently associated with isolation of a 3GC-R pathogen. Regarding the clinical outcomes, 22 out of 217 (10.1%) patients completing follow-up died at 30 days. At multivariate analysis 7-day clinical response was the only variable associated with 30-day mortality (OR 0.11, 95% CI 0.04-0.36, p < 0.001).

CONCLUSIONS

In our study, 35.9% of pathogens isolated in urine cultures of patients with community-acquired UTIs were non-susceptible to 3GC. In the ED, the knowledge of local epidemiology and of risk factors for antimicrobial resistance is of paramount importance for choosing the right empiric therapy and setting up local guidelines.

Carbapenem De-escalation in urinary tract infections: prevalence and outcomes among hospitalized patients

OBJECTIVE

To evaluate the prevalence and outcomes of carbapenem de-escalation among hospitalized urinary tract infection (UTI) patients at Jordan University Hospital from January 2022 to March 2024.

METHODS

This retrospective study included adult patients who received carbapenems as empirical therapy and underwent urine culture testing. Patients who were discharged before culture results (n = 31) were excluded. The primary outcome was to assess the rate of effective de-escalation, which is the transition to a narrower-spectrum antibiotic without therapeutic failure. Secondary outcomes included the effect on successful de-escalation on patients' hospital length of stay, and the relationship between urine culture results and the success of de-escalation. When determining whether to de-escalate, factors such as clinical stability, and urine culture results and susceptibility were considered. Chi-square test assessed associations between culture results and de-escalation success.

RESULTS

A total of 205 patients who received carbapenems as empirical therapy and underwent urine culture testing were included in the study. Out of these, 116 individuals (56.6%) had negative culture results, indicating no infection, while 89 individuals (43.4%) tested positive, confirming the presence of an infection. Among these patients, 95.6% (196 out of 205) required de-escalation of their treatment, whereas 4.4% did not. The prevalence of successful de-escalation was 40.3% (79 out of 196). The analysis revealed that successful de-escalation is much more likely in cases with urine cultures showing growth (86.8%) compared to those with no growth (17.2%) (p = 0.001). The study also indicated no significant differences in the length of hospital stay between the successfully de-escalated group and those who failed or were incorrectly de-escalated (P > 0.05).

CONCLUSIONS

The study underscores the challenges of implementing effective antibiotic stewardship in UTI management, particularly regarding carbapenem de-escalation. Enhanced protocols and clinician education are essential to optimize de-escalation practices, especially in cases with negative microbiological results. Further research is needed to refine these strategies and address the growing issue of antibiotic resistance in UTIs.

Nonenteric Pathogens in Urinary Tract Infections: Epidemiology and Resistance Patterns in Albania

Introduction: Antibiotic resistance is a growing global health crisis that complicates the treatment of urinary tract infections (UTIs). While Enterobacterales are primary UTI pathogens, nonenteric pathogens such as Pseudomonas aeruginosa, Burkholderia cepacia, and Enterococcus spp. are increasingly recognized, posing challenges due to their complex resistance mechanisms. This study aims to investigate the prevalence, resistance patterns, and multidrug resistance (MDR) of nonenteric pathogens in community-acquired UTIs in Albania. Materials and Methods: The study was conducted in an outpatient clinic from September 2023 to September 2024, involving adults (≥ 18 years) and excluding individuals with recent antibiotic use or pregnancy. Urine samples were processed using blood and MacConkey Agar, followed by bacterial identification and susceptibility testing with the VITEK 2 system. A total of 11 antibiotics belonging to β-lactams, fluoroquinolones, glycylcyclines, oxazolidinones, lipopeptides, glycopeptides, and tetracyclines were tested. Statistical analysis was performed using SPSS, with significance set at p < 0.05. Results: A total of 550 urine cultures were analyzed, of which 372 (67.6%) were positive for bacterial growth. Among these, 27.7% were identified as nonenteric pathogens, with a higher occurrence in females (66%) and young adults (18-39 years) (60.2%). Enterococcus faecalis was the most common Gram-positive pathogen (15.2% of the positive samples), while P. aeruginosa was the most frequent Gram-negative pathogen (9.1%). P. aeruginosa showed significant resistance to tigecycline (91.2%) and levofloxacin (38.2%), with no resistance to meropenem. E. faecalis showed high resistance to vancomycin (53.6%) and teicoplanin (46.4%), while S. saprophyticus showed moderate resistance. MDR prevalence was highest in P. aeruginosa (26.5%). Conclusion: This study highlights the high prevalence of community-acquired UTIs in Albania, particularly among females, and concerning MDR rates. To address these challenges, it is crucial to implement standardized treatment protocols, improve antibiotic stewardship, and promote research to track resistance patterns, ultimately enhancing patient care and combating antibiotic resistance.

Urinary tract infections and antimicrobial susceptibility: A retrospective trend analysis of uropathogens in women in Accra, Ghana (2019-2022)

Urinary tract infections (UTIs) remain a significant public health concern, with evolving patterns in prevalence and antimicrobial resistance. This retrospective study, conducted at the Greater Accra Regional Hospital in Accra, Ghana, analyzed 11,280 urine cultures obtained exclusively from female patients from 2019 to 2022 to assess trends in UTI burden, prevalence stratified by age and month, and antimicrobial susceptibility patterns. In all, urine pathogens were isolated in 4475 (39.67%) of the samples tested. Of the total number of uropathogens isolated, majority of them were bacterial pathogens (94.21%), with an increasing proportion of fungal infections, specifically candida species (5.79%). Irrespective of the year, the highest prevalence of uropathogens were consistently recorded in the month of May, while individuals aged ≥  90 years exhibited the greatest odds of infection in 2020 (aOR: 1.88, p = 0.039). Escherichia coli (30.51%) and Staphylococcus aureus (15.16%) were the most prevalent Gram-negative and Gram-positive pathogens, respectively. Antimicrobial susceptibility testing revealed declining antibiotic effectiveness over time, with notable exceptions for gentamicin (97.4% effectiveness against Enterococcus spp.) and ofloxacin (82.9% against Enterococcus spp.). Alarmingly, most antibiotics exhibited effectiveness rates below 20% by 2022, underscoring the growing resistance challenge. These findings, drawn from a key healthcare facility in Ghana's capital, highlight the dynamic nature of UTIs and the urgent need for targeted interventions, optimized antimicrobial stewardship, and continuous monitoring of resistance patterns to improve patient outcomes.

The antimycotic 5-fluorocytosine is a virulence inhibitor of uropathogenic Escherichia coli and eradicates biofilm-embedded bacteria synergizing with β-lactams

Biofilm can enhance antibiotic tolerance in bacteria, making treatment of biofilm-associated infections in clinical settings a significant challenge. 5-Fluorocytosine (5-FC), an FDA-approved drug mostly used as an antifungal, can hinder biofilm formation and production of virulence factors in Gram-negative bacteria. In this study, we tested 5-FC on nine uropathogenic Escherichia coli (UPEC) strains plus a fecal isolate. Our data indicated that 5-FC reduced curli fiber gene expression and inhibited virulence factors in UPEC strains. Unlike what was observed in other microorganisms, 5-FC antivirulence and antibiofilm properties were unaffected by either growth temperature or the medium pH, which might prove critical in urinary tract infection (UTI) treatment. Additionally, 5-FC impaired the expression of various UPEC virulence factors, including secreted toxins and type I and P fimbriae, thus leading to decreased UPEC adherence to bladder epithelial cells and improved survival of host cells. Finally, we found that a combination of 5-FC with β-lactams, but not other classes of antibiotics, significantly lowered the viability of bacteria in preformed biofilms. Despite a small set of pathogenic E. coli strains and an in vitro infection model, our findings strongly suggest that 5-FC might be a possible candidate as an antivirulence agent, particularly in a synergistic approach with β-lactam antibiotics.

Diagnostic and therapeutic strategies in combating implanted medical device-associated bacterial biofilm infections

Bacterial biofilms exhibit remarkable resistance against conventional antibiotics and are capable of evading the humoral immune response. They account for nearly 80% of chronic infections in humans. Development of bacterial biofilms on medical implants results in their malfunctioning and subsequently leads to high mortality rates worldwide. Therefore, early and precise diagnosis of bacterial biofilms on implanted medical devices is essential to prevent their failure and associated complications. Culture-based methods are time consuming, more prone to contamination and often exhibit low sensitivity. Different molecular, imaging, and physical methods can aid in more accurate and faster detection of implant-associated bacterial biofilms. Biofilm growth on implant surface can be prevented either through modification of the implant material or by application of different antibacterial coatings on implant surface. Experimental studies have shown that pre-existing biofilms from medical implants can be removed by breaking down biofilm matrix, utilizing physical methods, nanomaterials and antimicrobial peptides. The current review delves into mechanism of biofilm formation on implanted medical devices and the subsequent host immune response. Much emphasis has been laid on different ongoing diagnostic and therapeutic strategies to achieve improved patient outcomes and reduced socio-economic burden.

Rapid detection of β-lactamase activity using the rapid Amp NP test

Urinary tract infections (UTIs) are the most common bacterial infections in humans. They are mainly caused by Escherichia coli and other Enterobacterales for which increasing resistance to antibiotics and in particular to β-lactams is extensively reported. The detection of β-lactam resistance phenotypes is currently time-consuming (18 h). Hence, most treatments are given without any results of antibiotic susceptibility testing and may involve broad-spectrum antibiotics. A biochemical diagnostic test has been developed to rapidly evaluate the production of β-lactamases (and consequently the β-lactam resistance) from cultures (104 and 105 CFU/mL) of Gram-positive and Gram-negative isolates representative of bacterial species as a source of UTIs (n = 112). It relies on a centrifugation step after a 90 min preliminary culture and the detection of β-lactamase activity with nitrocefin as substrate using a special filter. Overall, the test gave a positive result for 87.6% of the tested resistant strains with a bacterial load of 105 CFU/mL, and a positive result for 100% of tested extended-spectrum β-lactamases and for carbapenemase producers at the same load. This cost-effective test can be performed in any laboratory and ultimately shall be tested at the patient side and at the general practitioner. Its turn-around-time to get results is less than 2 h. After further improvements, the results obtained with this proof-of-concept test suggest that its use may contribute to rapidly guide the treatment of non-complicated UTIs and, therefore, limit the use of broad-spectrum antibiotics and the emergence of antibiotic resistance.

IMPORTANCE

This work reports on a totally novel diagnostic technique, the Rapid Amp NP test for the identification of amoxicillin/ampicillin resistance in bacteria that are sources of non-complicated urinary tract infections. Those preliminary results obtained with cultured bacteria are promising. We believe its future use may contribute to reconsider aminopenicillins as a first line therapy for treating UTI infections. The corresponding patent of this test obtained both for the United States and Europe may contribute to its further industrialization.

Ochoa S, Xicohtencatl-Cortes J. Pathogenesis and Immunomodulation of Urinary Tract Infections Caused by Uropathogenic Escherichia coli

Urinary tract infections (UTIs) are a leading cause of illness in children and adults of all ages, with uropathogenic Escherichia coli (UPEC) being the primary agent responsible. During colonization and subsequent infection of the urinary tract (UT), UPEC requires the expression of genes associated with virulence, such as those that encode the fimbrial adhesins FimH, PapG, and CsgA, as well as the presence of the TosA protein and the flagellar appendages of the bacteria. However, for colonization and infection to be successful, UPEC must overcome the host's immunological barriers, such as physical barriers, expressed peptides and proteins, and immune cells found in the UT. In this context, the UT functions as an integral system where these factors act to prevent the colonization of uropathogens. Significant genetic diversity exists among UPEC strains, and the clonal complex ST131 represents one of the key lineages. This lineage has a high content of virulence genes, multiple mechanisms of antibiotic resistance, and a high frequency of extended-spectrum β-lactamases (ESBLs). New knowledge regarding protein structures known as adhesins and their role in the infection process can help identify therapeutic targets and aid in the design of vaccines. These vaccines could be based on the development of chimeric fusion proteins (FimH + CsgA + PapG), which may significantly reduce the incidence of UTIs in pediatric and adult patients.

Genomic and proteomic characterization of four novel Schitoviridae family phages targeting uropathogenic Escherichia coli strain

BACKGROUND

Escherichia coli-associated urinary tract infections (UTIs) are among the most prevalent bacterial infections in humans. Typically, antibiotic medication is used to treat UTIs, but over the time, growth of multidrug resistance among these bacteria has created a global public health issue that necessitates other treatment modalities, such as phage therapy.

METHODS

The UPEC strain PSU-5266 (UE-17) was isolated from human urine samples, while phages were obtained from wastewater. These phages were characterized through host range analysis, stability studies, adsorption assays, and electron microscopy. Additionally, genomic, phylogenetic, and proteomic analyses were conducted to provide further insights.

RESULTS

The current study describes the isolation and characterization of four Escherichia coli phages designated as UE-S5a, UE-S5b, UE-M3 and UE-M6. Bactericidal assays depicted that all bacteriophages exhibited a strong lytic ability against uropathogenic E. coli (UPEC) strain PSU-5266 (UE-17). The phages displayed a broad host range (31-41%) among 104 tested isolates and adsorption rate of 15-20 min. They were stable within pH range of 5-11 and temperature range of 4 to 55 °C. Electron microscopy showed that all phages have icosahedral heads (70-74 nm) and short non-contractile tails, thus exhibiting a podovirus morphology. Sequencing results showed that they have linear double stranded DNA, genome of 73 to 76 kb in length, with GC content of 42% and short direct terminal repeats. Their genomes contain 84-88 predicted genes with putative functions predicted to 42-48% of gene products. The phylogenetic and comparative genomic analysis results depicted that these phages, sharing > 98% sequence similarity, are new members of genus Gamaleyavirus of subfamily Enquatrovirinae, in the Schitoviridae family. Mass spectrometric analysis of purified phage particles identified 44-56 phage particle-associated proteins (PPAPs) belonging to various functional groups such as lysis proteins, structural proteins, DNA packaging related proteins, and proteins involved in replication, metabolism and regulation. In addition, no genes encoding virulence factors, antibiotic resistance or lysogeny factors were identified.

CONCLUSION

The overall findings suggest that these bacteriophages are potential candidates for phage therapy in treating UTIs caused by UPEC strains.

Novel Techniques to Unravel Causative Bacterial Ecological Shifts in Chronic Urinary Tract Infection

Chronic urinary tract infection (UTI) presents with protracted lower urinary tract symptoms and elevated urinary leukocyte counts, but its bacterial etiological agents remain obscure. In this cross-sectional investigation, we aimed to unravel the role of the bladder microbiota in chronic UTI pathogenesis by studying the host immune response. Urine samples were collected from healthy controls (HT), chronic UTI patients who had not initiated treatment (PT) and those undergoing treatment (OT), then sorted into white blood cell (WBC) and epithelial cell (EPC) fractions. Bacteria associated with both fractions were identified by chromogenic agar culture coupled with mass spectrometry and 16S rRNA sequencing. Distinct WBC-exclusive bacteria were observed in the healthy population, but this pattern was less obvious in patients, plausibly due to epithelial shedding and breaching of the urothelial barrier. We also described a bacterial fingerprint guided by Escherichia that was able to stratify patients based on symptom severity. Clustering analyses of mean rank changes revealed highly statistically significant upward and downward ecological shifts in communities of bacteria between the healthy and diseased populations. Interestingly, many of the most abundant genera identified in sequencing remained stable when compared between the study cohorts. We concluded that reshuffling of the urinary microbiome, rather than the activity of a single known urinary pathogen, could drive chronic UTI.

Probiotics and Plant-Based Foods as Preventive Agents of Urinary Tract Infection: A Narrative Review of Possible Mechanisms Related to Health

Urinary tract infections (UTIs) are a prevalent global health issue, often requiring antibiotic treatment, which contributes to antimicrobial resistance. This narrative review explores the potential of probiotics and plant-based foods as alternative or complementary preventive strategies against UTIs. Fermented foods, such as yogurt, kefir, and kombucha, contain probiotic strains that can modulate the gut and urogenital microbiota, enhancing resistance to uropathogens. Likewise, plant-based foods, including cranberry, garlic, bearberry, juniper, and nettle, possess bioactive compounds with antimicrobial, anti-inflammatory, and diuretic properties. Laboratory and clinical studies suggest that these natural interventions may reduce the incidence of UTIs by inhibiting pathogen adhesion, modulating immune responses, and promoting urinary tract health. However, despite promising findings, inconsistencies in study methodologies, dosage standardization, and long-term efficacy warrant further investigation. Future research should focus on optimizing probiotic formulations, standardizing plant-based supplement dosages, and assessing potential food-drug interactions to establish evidence-based guidelines for UTI prevention.

Antimicrobial susceptibility and risk factors of uropathogens in symptomatic urinary tract infection cases at Dessie Referral Hospital, Ethiopia

BACKGROUND

Urinary tract infection (UTI) is one of the most common bacterial infections encountered by clinicians in developing countries, affecting the urethra, bladder, and kidneys. It is a prevalent infectious disease among outpatients and hospitalized patients, leading to morbidity and mortality. Antibiotic resistance among uropathogens varies geographically, but empirical treatment is common in our study area. Therefore, this study aimed to evaluate antimicrobial susceptibility and risk factors of uropathogens in symptomatic UTI cases at Dessie Referral Hospital in northeast Ethiopia.

METHODS

A hospital-based cross-sectional study design was utilized to examine 256 participants with urinary tract complaints from February 1, 2024, to May 30, 2024. Consecutive convenience sampling was used to select participants. Midstream urine samples were collected, and bacteriological tests, including culture, Gram stain, biochemical tests, and antimicrobial susceptibility tests, were conducted following standard procedures. The data were entered into EpiData version 3.1 and analyzed using SPSS version 20 software. Bivariate and multivariate logistic regressions were carried out to identify potential risk factors associated with urinary tract infection.

RESULTS

The overall prevalence of bacteriuria was 22.7%. Escherichia coli (E. coli) accounted for the highest proportion 21(30.4%), followed by Coagulase-negative Staphylococcus (CoNS) at 15(21.7%) and Klebsiella spp 12(17.4%). Most Gram-positive bacteria were susceptible to gentamicin 19(90.5%) but less sensitive to trimethoprim-sulfamethoxazole 16(76.2%) and nitrofurantoin 18(85.7%). High resistance rates were observed for penicillin 9(60%) and cefoxitin 14(66.7%). On the other hand, amikacin (83.3%), gentamicin (81.3%), and nitrofurantoin (89.7%) were effective against Gram-negative bacteria. Resistance to tetracycline and ampicillin was reported at 53.8% against both groups of bacteria. Female sex (AOR = 4.21; 95% CI = 1.43-8.29, P = 0.002), diabetes mellitus (AOR = 14.786; 95% CI = 3.91-70.72, P = 0.001), and human immunodeficiency virus positivity (AOR = 5.273; 95% CI = 2.596-17.410, P = 0.002) were identified as significant risk factors for bacteriuria.

CONCLUSION

The prevalence of UTI among syptomatic patients was 22.7%. E. coli and coagulase negative Staphylococcus were the predominant isolates. The identified bacteria were resistant to commonly use antimicrobials. Therefore, there should be continuous surveillance of UTI and antimicrobial susceptibility testing to minimize urinary tract infection and antibiotic resistance in our study setting.

Efficacy of treatment options for complicated urinary tract infections including acute pyelonephritis: a systematic literature review and network meta-analysis

Aim: Compared with uncomplicated urinary tract infections (UTIs), complicated UTIs (cUTIs) including acute pyelonephritis (AP) present with significant morbidity, a higher risk of treatment failure and typically require longer courses of treatment, or alternative antibiotics. The emergence of drug-resistant organisms represents a considerable challenge in the treatment of patients with cUTIs/AP and has limited antibiotic options. Carbapenems are considered the current last line of therapy, however, carbapenem resistance represents a growing problem. Although several established and novel treatment options are available, direct comparative evidence is lacking. Methods: Randomized controlled trials (RCTs) were identified by systematic literature review of Embase®, MEDLINE® and Cochrane databases (database inception to 15th June 2022). Relevant conference proceedings (2020-2022) were also reviewed. Following feasibility assessment to verify network connectivity at an overall level, outcome specific networks were prepared. Bayesian network meta-analysis (NMA) was performed (using R version 4.2.1) to determine the relative efficacy of various treatments for cUTI/AP, including cefepime + enmetazobactam. Convergence was assessed by visual inspection of trace plots. The accuracy of the posterior estimates was assessed using the Monte Carlo error for each parameter. Published study results were included in the synthesis of the relative risk (RR) of efficacy end points, using a logit link with binomial likelihood distribution. Results: Feasibility assessment was conducted for 40 RCTs identified, to assess the viability of constructing a network of interlinked RCTs. Of those, 28 studies were included in the master NMA network. A fixed effects model (FEM) was selected due to low statistical heterogeneity, according to I2 values. For composite outcome at test of cure (TOC), ceftolozane + tazobactam, cefepime + enmetazobactam, cefiderocol, levofloxacin and plazomicin demonstrated significantly higher RRs versus carbapenems. For microbiological eradication at TOC, cefepime + enmetazobactam, plazomicin, cefiderocol, fosfomycin, meropenem + vaborbactam and ceftazidime + avibactam demonstrated significantly higher RRs versus carbapenems. RRs for cefepime + enmetazobactam were also significantly higher versus several established and novel treatment options for composite outcome, microbiological eradication and clinical cure. Conclusion: Against the backdrop of increasing bacterial resistance, these findings suggest that cefepime + enmetazobactam may represent an effective carbapenem-sparing treatment option in patients with cUTI including AP.

Bacterial adhesion strategies and countermeasures in urinary tract infection

Urinary tract infections (UTIs) are compounded by antimicrobial resistance, which increases the risk of UTI recurrence and antibiotic treatment failure. This also intensifies the burden of disease upon healthcare systems worldwide, and of morbidity and mortality. Uropathogen adhesion is a critical step in the pathogenic process, as has been mainly shown for Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus agalactiae, Proteus, Enterococcus and Staphylococcus species. Although many bacterial adhesion molecules from these uropathogens have been described, our understanding of their contributions to UTIs is limited. Here we explore knowledge gaps in the UTI field, as we discuss the broader repertoire of uropathogen adhesins, including their role beyond initial attachment and the counter-responses of the host immune system. Finally, we describe the development of therapeutic approaches that target uropathogenic adhesion strategies and provide potential alternatives to antibiotics.

Cranberry-derived bioactives for the prevention and treatment of urinary tract infections: antimicrobial mechanisms and global research trends in nutraceutical applications

Introduction

Urinary tract infections (UTIs) are a global health concern, increasingly complicated by antibiotic resistance. Cranberry-derived bioactive compounds, particularly proanthocyanidins (PACs), have emerged as a promising non-antibiotic strategy for UTI prevention. This review examines their efficacy, mechanisms of action, and the evolving research landscape through bibliometric analysis.

Methods

A comprehensive literature review was conducted to assess the role of cranberry metabolites in UTI prevention, focusing on anti-adhesive and antimicrobial mechanisms. Additionally, a bibliometric analysis of publications from 1962 to 2024 was performed to evaluate research trends, collaboration networks, and thematic developments.

Results

Cranberry metabolites, particularly A-type PACs, flavonoids, and phenolic acids, inhibit Escherichia coli adhesion to urothelial cells, reducing UTI recurrence. Gut microbiota-driven transformation of PACs into bioactive metabolites enhances their efficacy, while cranberry oligosaccharides disrupt biofilm formation in high-risk populations. Bibliometric analysis reveals a surge in research interest post-2000, with increasing global collaborations and a focus on clinical applications.

Discussion and conclusion

Cranberry bioactives demonstrate significant potential in UTI management, yet variations in formulation, dosage, and metabolic bioavailability present challenges. The growing research interest underscores the need for standardized clinical studies to optimize therapeutic efficacy and establish evidence-based guidelines for their use.

Prevalence of recurrent urinary tract infections and its associated factors in female staff of reproductive age group in a medical college in central Kerala: a cross-sectional study

AIM

To study the prevalence of recurrent urinary tract infections (UTIs) and its associated factors in female staff of reproductive age group in a medical college in central Kerala.

INTRODUCTION

Recurrent UTIs can be defined as ≥ 3 episodes of UTIs within a period of 12 months. Females with recurrent UTIs have lower health-related quality of life compared to the general population; the incidence of UTI in women of reproductive age group is very common. This study focused on female employees of reproductive age group in a private medical college.

METHODS

A cross-sectional study was done among female staff of reproductive age group in a private medical college in central Kerala, with a sample size of 417. All female staff (18-49 years) were given a questionnaire and asked to fill it out. All those who filled out the questionnaire were included in the study according to both inclusion and exclusion criteria. Data entry and analysis were performed via Microsoft Excel 2019 and SPSS version 22.0.

RESULT

Our study of 417 participants revealed a prevalence of recurrent UTIs of 22.30% (95% CI = 18.3- 26.3%). Recurrent UTI was significantly associated with daily water intake, urination frequency, holding urine, foul-smelling vaginal discharge, constipation, pre-coital urination, and pre- and post-intercourse vaginal hygiene. Also, occupation was found to be significantly associated with recurrent UTI, with cleaning staff having higher odds.

CONCLUSION

Our study found the prevalence of recurrent UTI in 417 population as 22.30%. Prevention of recurrent UTI requires a daily intake of > 2 L of water and personal & sexual hygiene. Reducing recurrent UTIs enhances quality of life. Educating female staff is crucial.

A model for predicting bacteremia species based on host immune response

Introduction

Clinicians encounter significant challenges in quickly and accurately identifying the bacterial species responsible for patient bacteremia and in selecting appropriate antibiotics for timely treatment. This study introduces a novel approach that combines immune response data from routine blood counts with assessments of immune cell activation, specifically through quantitative measurements of Rho family GTPase activity. The combined data were used to develop a machine-learning model capable of distinguishing specific classes of bacteria and their associations.

Methods

We aimed to determine whether different classes of bacteria elicit distinct patterns of host immune responses, as indicated by quantitative differences in leukocyte populations from routine complete blood counts with differential. Concurrently, we conducted quantitative measurements of activated Rac1 (Rac1•GTP) levels using a novel 'G-Trap assay' we developed. With the G-Trap, we measured Rac1•GTP in peripheral blood monocytes (PBMC) and polymorphonuclear (PMN) cells from blood samples collected from 28 culture-positive patients and over 80 non-infected patients used as controls.

Results

Our findings indicated that 18 of the 28 patients with bacteremia showed an increase of ≥ 3-fold in Rac1•GTP levels compared to the controls. The remaining ten patients with bacteremia exhibited either neutrophilia or pancytopenia and displayed normal to below-normal Rac1 GTPase activity, which is consistent with bacteria-induced immunosuppression. To analyze the data, we employed partial least squares discriminant analysis (PLS-DA), a supervised method that optimizes group separation and aids in building a novel machine-learning model for pathogen identification.

Discussion

The results demonstrated that PLS-DA effectively differentiates between specific pathogen groups, and external validation confirmed the predictive model's utility. Given that bacterial culture confirmation may take several days, our study underscores the potential of combining routine assays with a machine-learning model as a valuable clinical decision-support tool. This approach could enable prompt and accurate treatment on the same day that patients present to the clinic.

Effect of Inadequate Treatment in Adult Patients with Community-Acquired Acute Pyelonephritis Due to Enterobacterales Under Empirical Management with Cefazolin

Background/Objectives: First-generation cephalosporins are used in some countries, primarily in Latin America and other low-resource regions, as a first-line or alternative empirical treatment for patients with acute pyelonephritis (AP). This study aimed to evaluate the impact of inappropriate empirical therapy with cefazolin on the clinical outcomes of adult patients with community-acquired AP caused by resistant Enterobacterales, requiring hospitalization in two tertiary hospitals in Bogotá. Methods: This retrospective cohort study included hospitalized patients with community-acquired AP caused by Enterobacterales who received initial treatment with cefazolin at two tertiary-level institutions in Colombia (January 2013-2020). Inappropriate treatment was defined as a resistant isolate to cefazolin in the urine culture. Outcomes assessed included hospital stay, hospital mortality, and recurrence. Results: A total of 1031 patients were admitted, among whom 218 (21.1%) received inappropriate treatment. The mean length of stay was 4.8 (5.1) days, 996 (96.6%) survived to discharge, and 113 (11.0%) were admitted for a recurrence of AP. Inappropriate treatment had no impact on hospital stay (RRA 0.98, 95% CI 0.84-1.15) or hospital mortality (OR 1.02, 95% CI 0.47-2.19), although it was associated with a greater risk of admission because of recurrence (OR 3.7, 95% CI 2.4-5.8). Conclusions: We found that inadequate empirical treatment with cefazolin in adult patients with community-acquired acute pyelonephritis does not appear to change the length of hospital stay or in-hospital mortality in patients but is associated with an increased risk of readmission due to recurrence; this might favor the use of empirical narrow-spectrum antibiotics but with strategies that allow monitoring or early detection of microbiological non-eradication to prevent recurrence.

Managing Recurrent Urinary Tract Infections After Spinal Cord Injury: Practical Approaches and Emerging Concepts

The majority of individuals with neurogenic lower urinary tract dysfunction will have complicated urinary tract infections (UTIs) that will qualify as recurrent. Existing inconsistencies and challenges contribute to its subjective diagnosis. Thus, there is a pressing need for a reconceptualization of our understanding of UTI, accompanied by a paradigm shift in diagnosis and treatment approaches.

Bioactive Compounds as Alternative Approaches for Preventing Urinary Tract Infections in the Era of Antibiotic Resistance

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide. They occur in the urinary system when a microorganism, commonly present on the perineal skin or rectum, reaches the bladder through the urethra, and adheres to the luminal surface of uroepithelial cells, forming biofilms. The treatment of UTIs includes antibiotics, but their indiscriminate use has favored the development of multidrug-resistant bacteria strains, which represent a serious challenge to today's microbiology. The pathogenesis of the infection and antibiotic resistance synergistically contribute to hindering the eradication of the disease while favoring the establishment of persistent infections. The repeated requirement for antibiotic treatment and the limited therapeutic options have further contributed to the increase in antibiotic resistance and the occurrence of potential relapses by therapeutic failure. To limit antimicrobial resistance and broaden the choice of non-antibiotic preventive approaches, this review reports studies focused on the bacteriostatic/bactericidal activity, inhibition of bacterial adhesion and quorum sensing, restoration of uroepithelial integrity and immune response of molecules, vitamins, and compounds obtained from plants. To date, different supplementations are recommended by the European Association of Urology for the management of UTIs as an alternative approach to antibiotic treatment, while a variety of bioactive compounds are under investigation, mostly at the level of in vitro and preclinical studies. Although the evidence is promising, they are far from being included in the clinical practice of UTIs.

Urinary tract infections: pathogenesis, host susceptibility and emerging therapeutics

Urinary tract infections (UTIs), which include any infection of the urethra, bladder or kidneys, account for an estimated 400 million infections and billions of dollars in health-care spending per year. The most common bacterium implicated in UTI is uropathogenic Escherichia coli, but diverse pathogens including Klebsiella, Enterococcus, Pseudomonas, Staphylococcus and even yeast such as Candida species can also cause UTIs. UTIs occur in both women and men and in both healthy and immunocompromised patients. However, certain patient factors predispose to disease: for example, female sex, history of prior UTI, or the presence of a urinary catheter or other urinary tract abnormality. The current clinical paradigm for the treatment of UTIs involves the use of antibiotics. Unfortunately, the efficacy of this approach is dwindling as the prevalence of antimicrobial resistance rises among UTI isolates, and the immense quantity of antibiotics prescribed annually for these infections contributes to the emergence of resistant pathogens. Therefore, there is an urgent need for new antibiotics and non-antibiotic treatment and prevention strategies. In this Review, we discuss how recent studies of bacterial pathogenesis, recurrence, persistence, host-pathogen interactions and host susceptibility factors have elucidated new and promising targets for the treatment and prevention of UTIs.

Antibiotic Overprescription for "Urinary Tract Infections" Is Associated With Poor Diagnostic Stewardship and Low Adherence to Guidelines

PURPOSE

While urinary tract infections (UTIs) are thought to be common among women, as many as 65% of UTI diagnoses may be inaccurate. To identify strategies to improve antibiotic stewardship, we sought to determine the clinical and laboratory factors associated with overdiagnosis and overtreatment of UTIs.

METHODS

Electronic health records identified patients bearing an isolated diagnostic code for UTI within a single healthcare system during July 2019. Demographic, clinical, and microbial data were collected by manual chart review. Regression analyses were utilized to determine factors associated with guideline non-concordant UTI diagnosis and treatment utilizing R statistical software (version 4.3.1).

RESULTS

In patients diagnosed with UTI, 64% were treated with antibiotics despite only 28% having symptoms consistent with UTI diagnostic criteria. Of patients diagnosed with a UTI who were treated in an emergency room (ER) setting, 95% were given antibiotics compared with only 55% of patients in an outpatient setting. Even without any urinary symptoms, 95% of patients in the ER and 27% of patients in outpatient settings were treated with antibiotics. Patients who presented to the ER for non-localizing symptoms, such as mental status changes (MSC), were more likely to be diagnosed with UTI compared with those in an outpatient setting.

CONCLUSION

The results of this study demonstrate that patients were frequently diagnosed with and treated for a UTI despite not meeting diagnostic criteria. This pattern of overdiagnosis leads to overtreatment, particularly in acute care settings, contributing to worsening antibiotic resistance in conjunction with incomplete evaluation of patients' primary complaints.

Characterization of the Phenotypic and Genotypic Antibiotic Resistance Markers in Escherichia coli (E. coli) Associated With Diabetes and Nondiabetic Patients

Introduction: Individuals with diabetes are more susceptible to urinary tract infections (UTIs) than those without the disease. This study aimed to determine the phenotypic and genotypic antibiotic resistance profiles of Escherichia coli in diabetic and nondiabetic patients. Methodology: A total of 374 clean-catch midstream urine specimens were screened for uropathogens, and antibiogram analysis was done on E. coli isolates by the Kirby-Bauer disc diffusion method, followed by phenotypic confirmation of extended spectrum beta-lactamase (ESBL) production. In addition, polymerase chain reaction (PCR) assays were carried out to determine ESBL genotypes. Result: Overall, we observed UTIs prevalence of 19.8% and 10.7% in diabetic and nondiabetic patients. Females exhibited higher UTI prevalence than males in both groups ([71.8% and 28.2%] vs. [85% and 15%]) (p < 0.0001). Among women with and without diabetes, the age groups of 55-64 and 25-34 years showed the highest prevalence of UTIs (25.6% vs. 40%). The most prevalent uropathogen was E. coli (62.2% vs. 75%); multidrug-resistant (MDR) E. coli was (61% vs. 33.3%) and ESBL-E. coli was (34.8% and 20%) in diabetic and nondiabetic patients, respectively. The most common ESBL-mediated gene was blaCTX-M (64.3%) with multiple ESBL genes in some E. coli isolates. High-level resistance was observed for ampicillin (91.2%), cefuroxime (96.7%), ciprofloxacin (44.9%), and trimethoprim (59.4%), and low-level resistance was observed for gentamicin (18.7%), ceftriaxone (20.9%), and nitrofurantoin (19.8%). There was no significant difference between antibiotic resistance in diabetic and nondiabetic patients (p > 0.05). Conclusion: We observed blaCTX-M as the most common ESBL genotype, in combination with other ESBL genes present in some E. coli isolates. Nitrofurantoin and ceftriaxone antibiotics were efficacious. Appropriate prescription of antibiotic therapy, and the prevention of transmission of resistant genes in the context of public health can be facilitated by routine monitoring of the resistance profiles and ESBL markers in patients with and without diabetes.

Proteomic insights into dual-species biofilm formation of E. coli and E. faecalis on urinary catheters

Infections associated with urinary catheters are often caused by biofilms composed of various bacterial species that form on the catheters' surfaces. In this study, we investigated the intricate interplay between Escherichia coli and Enterococcus faecalis during biofilm formation on urinary catheter segments using a dual-species culture model. We analyzed biofilm formation and global proteomic profiles to understand how these bacteria interact and adapt within a shared environment. Our findings demonstrated dynamic population shifts within the biofilms, with E. coli initially thriving in the presence of E. faecalis, then declining during biofilm development. E. faecalis exhibited a rapid decrease in cell numbers after 48 h in both single- and dual-species biofilms. Interestingly, the composition of the dual-species biofilms was remarkably diverse, with some predominantly composed of E. coli or of E. faecalis; others showed a balanced ratio of both species. Notably, elongated E. faecalis cells were observed in dual-species biofilms, a novel finding in mixed-species biofilm cultures. Proteomic analysis revealed distinct adaptive strategies E. coli and E. faecalis employed within biofilms. E. coli exhibited a more proactive response, emphasizing motility, transcription, and protein synthesis for biofilm establishment; whereas E. faecalis displayed a more reserved strategy, potentially downregulating metabolic activity, transcription, and translation in response to cohabitation with E. coli. Both E. coli and E. faecalis displayed significant downregulation of virulence-associated proteins when coexisting in dual-species biofilms. By delving deeper into these dynamics, we can gain a more comprehensive understanding of challenging biofilm-associated infections, paving the way for novel strategies to combat them.

Force-bearing phagocytic adhesion rings mediate the phagocytosis of surface-bound particles

Many micro-particles including pathogens strongly adhere to hosts. It remains elusive how macrophages detach these surface-bound particles during phagocytosis. We show that, rather than binding directly to these particles, macrophages form unique β2 integrin-mediated adhesion structures at the cell-substrate interfaces, specifically encircling the surface-bound particles. These circular adhesion structures that we named phagocytic adhesion rings (PARs) serve as strongholds to support local ring-shaped actin structures constricting into the particle-substrate cleavages, thereby pinching off the particles from the substrate. During this process, integrins in PARs sustain tensions due to the reaction force of actin polymerization against the particles. Such tensions are critical for phagocytic efficiency of surface-bound particles. PARs were formed in all tested macrophages (mouse, human and fish) and micron-sized particles (microbeads and E. coli), demonstrating their conserved role in the phagocytosis. This study reveals a mechanism of PAR-mediated phagocytosis, specialized for the detachment and internalization of surface-bound particles.

Tamm-Horsfall protein augments neutrophil NETosis during urinary tract infection

Urinary neutrophils are a hallmark of urinary tract infection (UTI), yet the mechanisms governing their activation, function, and efficacy in controlling infection remain incompletely understood. Tamm-Horsfall glycoprotein (THP), the most abundant protein in urine, uses terminal sialic acids to bind an inhibitory receptor and dampen neutrophil inflammatory responses. We hypothesized that neutrophil modulation is an integral part of THP-mediated host protection. In a UTI model, THP-deficient mice showed elevated urinary tract bacterial burdens, increased neutrophil recruitment, and more severe tissue histopathological changes compared with WT mice. Furthermore, THP-deficient mice displayed impaired urinary NETosis during UTI. To investigate the effect of THP on NETosis, we coupled in vitro fluorescence-based NET assays, proteomic analyses, and standard and imaging flow cytometry with peripheral human neutrophils. We found that THP increases proteins involved in respiratory chain, neutrophil granules, and chromatin remodeling pathways; enhances NETosis in an ROS-dependent manner; and drives NET-associated morphologic features including nuclear decondensation. These effects were observed only in the presence of a NETosis stimulus and could not be solely replicated with equivalent levels of sialic acid alone. We conclude that THP is a critical regulator of NETosis in the urinary tract, playing a key role in host defense against UTI.

A Novel Silver-Ruthenium-Based Antimicrobial Kills Gram-Negative Bacteria Through Oxidative Stress-Induced Macromolecular Damage

Amplified by the decline in antibiotic discovery, the rise of antibiotic resistance has become a significant global challenge in infectious disease control. Extraintestinal Escherichia coli (ExPEC), known to be the most common instigators of urinary tract infections (UTIs), represent such global threat. Novel strategies for more efficient treatments are therefore desperately needed. These include silver nanoparticles, which have been used as antimicrobial surface-coatings on catheters to eliminate biofilm-forming uropathogens and reduce the risk of nosocomial infections. AGXX® is a promising silver coating that presumably kills bacteria through the generation of reactive oxygen species (ROS) but is more potent than silver. However, neither is AGXX®'s mode of action fully understood, nor have its effects on Gram-negative bacteria or bacterial response and defense mechanisms towards AGXX® been studied in detail. Here, we report that the bactericidal effects of AGXX® are primarily based on ROS formation, as supplementation of the media with a ROS scavenger completely abolished AGXX®-induced killing. We further show that AGXX® impairs the integrity of the bacterial cell envelope and causes substantial protein aggregation and DNA damage already at sublethal concentrations. ExPEC strains appear to be more resistant to the proteotoxic effects of AGXX® compared to non-pathogenic E. coli, indicating improved defense capabilities of the uropathogen. Global transcriptomic studies of AGXX®-stressed ExPEC revealed a strong oxidative stress response, perturbations in metal homeostasis, as well as the activation of heat shock and DNA damage responses. Finally, we present evidence that ExPEC counter AGXX® damage through the production of the chaperone polyphosphate.

Retrospective Analysis of Antibiotic Resistance Patterns of Uropathogenic Escherichia coli With Focus on Extended-Spectrum β-Lactamase at a Tertiary Central Hospital in Saudi Arabia

Background and Aims

Urinary tract infections (UTIs) are a prevalent bacterial infection that has substantial implications for healthcare on a global scale. Escherichia coli (E. coli) is a gram-negative rod responsible for most UTI cases. ESBL-producing E. coli is widely recognized as a significant contributor to antibiotic resistance. This study aims to evaluate the prevalence and antibiotic resistance trends of ESBL-producing E. coli in patients with UTIs at a tertiary hospital in Jazan, Saudi Arabia.

Methods

A retrospective cross-sectional analysis was conducted on 347 urine specimens collected between January 2022 and March 2023.

Results

The study found that 31% of E. coli specimens were positive for ESBL. Among patients with ESBL-producing E. coli, 78.9% were females, and the majority of ESBL-producing E. coli cases were observed in the outpatient clinic departments. Among all E. coli isolates, ampicillin exhibited the highest resistance rate at 69.3%, aztreonam at 66.7%, and colistin at the lowest resistance. ESBL-producing E. coli strains exhibited higher resistance rates than non-ESBL-producing E. coli strains.

Conclusion

The study agrees with others in the region and shows a higher prevalence of ESBL-producing E. coli in the region, emphasizing the importance of antibiotic stewardship programs and infection control measures to mitigate the prevalence and spread of ESBL-producing E. coli in our region.

Antibiotic resistance patterns in uropathogens: insights from a Nepalese tertiary care setting

Background

Antimicrobial resistance in uropathogens is increasing globally, particularly in resource-limited settings such as Nepal, limiting treatment options.

Objectives

This study aimed to evaluate the antimicrobial resistance patterns of uropathogens isolated from patients with urinary tract infections (UTIs) in a tertiary care hospital in central Nepal.

Design

This study utilized a retrospective study design.

Methods

We retrospectively observed medical records from August 2023 to February 2024 at Manmohan Memorial Teaching Hospital in Nepal, focusing on patients with significant bacterial growth in urine samples and antibiotic sensitivity analysis for resistance trends.

Results

Escherichia coli (E. coli) (64.7%) and Klebsiella pneumoniae (K. pneumoniae) (15.0%) were the most common uropathogens. Both showed the highest resistance to amoxicillin (>95%), while E. coli demonstrated the lowest resistance to gentamicin (7.4%) and nitrofurantoin (12.2%). Klebsiella pneumoniae also showed low resistance to gentamicin (12.0%) but higher resistance to nitrofurantoin (64.0%).

Conclusion

Empirical therapy, including nitrofurantoin and aminoglycosides, is a viable option for combating antimicrobial resistance in Nepal, necessitating region-specific surveillance and multicentre studies.

Trends in Escherichia coli and Klebsiella pneumoniae Urinary Tract Infections and Antibiotic Resistance over a 5-Year Period in Southeastern Gabon

Background: Urinary tract infections (UTIs) are a substantial global health concern, exacerbated by the widespread use of antibiotics and leading to the development of multidrug-resistant strains. The aim of this study was to analyze the temporal patterns of Escherichia coli and Klebsiella pneumoniae UTIs and antibiotic resistance, taking into account various sociodemographic, clinical, and climatic factors within the study population. Methods: A total of 3026 urine samples from patients of all ages were analyzed over a period of five years by standard microbiological methods. Climatic data for the study area were also collected. Univariate and multivariate logistic regression analyses were performed to measure the impact of sociodemographic, clinical and climatic parameters on the occurrence of UTIs. Results: The study showed a 31.4% prevalence of UTIs among the population. Notably, there was a significant increase in pyelonephritis between 2019 and 2023 (p < 0.01). Furthermore, a significant association was found between cystitis and the long dry season, as well as the short rainy season. Furthermore, Escherichia coli and Klebsiella pneumoniae exhibited resistance to beta-lactams, quinolones, and co-trimoxazole. The resistance of Escherichia coli isolated from cystitis to nitrofurantoin showed a significant increase over the years (p < 0.04). Principal component analysis (PCA) suggested that humidity may play a role in the emergence of multidrug-resistant strains of Escherichia coli and Klebsiella pneumoniae. Conclusions: UTIs show variability according to various sociodemographic, clinical, and climatic factors, with a higher risk of complications seen in individuals aged ≤ 17 years. It is important to note that cases of pyelonephritis have been increasing over time, with a noticeable seasonal variation. This study suggests that humidity may play a role in promoting antibiotic multidrug resistance in Escherichia coli and Klebsiella pneumoniae.

Disparities in the Prevalence of Urinary Diseases Among Prisoners in Taiwan: Population-Based Cross-Sectional Study

BACKGROUND

Prisoner health is a major global concern, with prisoners often facing limited access to health care and enduring chronic diseases, infectious diseases, and poor mental health due to unsafe prison environments, unhygienic living conditions, and inadequate medical resources. In Taiwan, prison health is increasingly an issue, particularly concerning urinary diseases such as urinary tract infections. Limited access to health care and unsanitary conditions exacerbate these problems. Urinary disease epidemiology varies by sex and age, yet studies in Asia are scarce, and comprehensive data on urinary diseases in Taiwanese prisons remain limited.

OBJECTIVE

This study aimed to investigate the prevalence of urinary diseases among Taiwanese prisoners and explore the differences in disease prevalence between men and women, as well as across different age groups.

METHODS

This study used data on prisoners from the National Health Insurance Research Database covering the period from January 1 to December 31, 2013. Prisoners covered by National Health Insurance who were diagnosed with urinary diseases, identified by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes 580-599 based on their medical records, and had more than one medical visit to ambulatory care or inpatient services were included. Sex- and age-stratified analyses were conducted to determine the differences in the prevalence of urinary diseases.

RESULTS

We examined 83,048 prisoners, including 2998 with urinary diseases. The overall prevalence of urinary system diseases among prisoners was 3.61% (n=2998; n=574, 6.64% in men and n=2424, 3.26% in women). The prevalence rate in men was significantly lower than that in women (prevalence ratio: 0.46, P<.001). In age-stratified analysis, the prevalence rate among prisoners aged >40 years was 4.5% (n=1815), compared to 2.77% (n=1183) in prisoners aged ≤40 years. Prisoners aged >40 years had a higher prevalence (prevalence ratio: 1.69, P<.001). Other disorders of the urethra and urinary tract (ICD-9-CM: 599), including urinary tract infection, urinary obstruction, and hematuria, were the most prevalent diseases of the urethra and urinary tract across age and sex groups. Women and older prisoners had a higher prevalence of most urinary tract diseases. There were no significant sex-specific differences in adjusted prevalence ratios for acute glomerulonephritis, nephrotic syndrome, kidney infections, urethritis (nonsexually transmitted), or urethral syndrome. However, based on the age-specific adjusted prevalence ratio analysis, cystitis was more prevalent among younger prisoners (prevalence ratio: 0.69, P=.004).

CONCLUSIONS

Urinary system infections and inflammation are common in prisons. Our findings advocate for policy reforms aimed at improving health care accessibility in prisons, with a particular focus on the needs of high-risk groups such as women and older prisoners. Further research linking claims data with prisoner information is crucial to providing more comprehensive medical services and achieving health equity.

Prevalence of Antimicrobial Resistance Among the WHO's AWaRe Classified Antibiotics Used to Treat Urinary Tract Infections in Diabetic Women

Background and Objectives: Diabetes is linked to a higher risk of urinary tract infections (UTIs) in women, often leading to recurrent antibiotic treatments. Frequent antibiotic use for UTIs can contribute to antimicrobial resistance (AMR), a critical public health threat that increases treatment failure. This study investigated the prevalence of AMR and its associated factors among women with UTIs, comparing those with and without diabetes. Results: The study population had a mean age of 52 years (SD = 23) for the women without diabetes and 68 years (SD = 14) for those with diabetes. Resistance was highest for cefazolin and levofloxacin in the Access and Watch antibiotic groups, while ciprofloxacin was the most frequently prescribed antibiotic. AMR prevalence was 35.7% among the women with diabetes and 21.3% among those without. After adjustment, AMR was significantly associated with both uncomplicated diabetes (OR 1.14, 95% CI 1.08-1.21) and complicated diabetes (OR 1.54, 95% CI 1.45-1.64), as well as with higher numbers of prescribed antibiotics (OR 277.39, 95% CI 253.79-303.17). Methods: Using a cross-sectional cohort from the Physionet database, we analyzed data on 116,902 female participants treated for UTIs, including their antibiotic exposure, diabetes status, comorbidities, and hospital admission details. Antimicrobials were classified per the WHO's AWaRe criteria. The primary outcome was AMR identified in urine cultures, and the association with diabetes status was evaluated using multivariable logistic regression. Conclusions: Our findings highlight the need for focused antimicrobial stewardship in women with diabetes to reduce the AMR rates in this vulnerable group.

The rise, fall, and resurgence of phage therapy for urinary tract infection

In the face of rising antimicrobial resistance, bacteriophage therapy, also known as phage therapy, is seeing a resurgence as a potential treatment for bacterial infections including urinary tract infection (UTI). Primarily caused by uropathogenic Escherichia coli, the 400 million UTI cases annually are major global healthcare burdens and a primary cause of antibiotic prescriptions in the outpatient setting. Phage therapy has several potential advantages over antibiotics including the ability to disrupt bacterial biofilms and synergize with antimicrobial treatments with minimal side effects or impacts on the microbiota. Phage therapy for UTI treatment has shown generally favorable results in recent animal models and human case reports. Ongoing clinical trials seek to understand the efficacy of phage therapy in individuals with asymptomatic bacteriuria and uncomplicated cystitis. A possible challenge for phage therapy is the development of phage resistance in bacteria during treatment. While resistance frequently develops in vitro and in vivo, resistance can come with negative consequences for the bacteria, leaving them susceptible to antibiotics and other environmental conditions and reducing their overall virulence. "Steering" bacteria toward phage resistance outcomes that leave them less fit or virulent is especially useful in the context of UTI where poorly adherent or slow-growing bacteria are likely to be flushed from the system. In this article, we describe the history of phage therapy in treating UTI and its current resurgence, the state of its clinical use, and an outlook on how well-designed phage therapy could be used to "steer" bacteria toward less virulent and antimicrobial-susceptible states.

Monoclonal antibodies targeting the FimH adhesin protect against uropathogenic E. coli UTI

As antimicrobial resistance increases, urinary tract infections (UTIs) are expected to pose an increased burden in morbidity and expense on the healthcare system, increasing the need for alternative antibiotic-sparing treatments. Most UTIs are caused by uropathogenic Escherichia coli (UPEC), while Klebsiella pneumoniae causes a significant portion of non-UPEC UTIs. Both bacteria express type 1 pili tipped with the mannose-binding FimH adhesin critical for UTI pathogenesis. We generated and biochemically characterized 33 murine monoclonal antibodies (mAbs) to FimH. Two mAbs protected mice from E. coli UTI. Mechanistically, we show that this protection is Fc-independent and mediated by the ability of these mAbs to sterically block FimH function. Our data reveals that FimH mAbs hold promise as an antibiotic-sparing treatment strategy.

Harnessing the host response for precision infectious disease diagnosis

SUMMARYDetection of the presence of infection and its etiology must be accurate and timely to facilitate appropriate antimicrobial use. Diagnostic strategies that rely solely on pathogen detection often are insufficient due to poor test characteristics, inability to differentiate colonization from infection, or protracted delay to result. Understanding the human response across different pathogens on a clinical and molecular level can provide more accurate, timely, and useful answers, especially in critical illness and diagnostic uncertainty. Improvements in understanding the human immune response including genomics, protein analysis, gene expression, and cellular morphology have led to rapid innovation of new host response-based diagnostic tests. This review describes the limitations of pathogen-focused technology and the benefits of examining the breadth of immune response to diagnose infection. It then explores biomarkers that have been studied for this purpose and scrutinizes the performance of host-based multianalyte testing. Currently cleared diagnostics and those in late-stage development are described in depth, with a focus on the purpose of testing and its utility for clinicians. Finally, it concludes by examining opportunities for further host response-derived diagnostic innovation.

A step forward in the diagnosis of urinary tract infections: from machine learning to clinical practice

Objectives

Urinary tract infections (UTIs) are common infections within the Emergency Department (ED), causing increased laboratory workloads and unnecessary antibiotics prescriptions. The aim of this study was to improve UTI diagnostics in clinical practice by application of machine learning (ML) models for real-time UTI prediction.

Methods

In a retrospective study, patient information and outcomes from Emergency Department patients, with positive and negative culture results, were used to design models - 'Random Forest' and 'Neural Network' - for the prediction of UTIs. The performance of these predictive models was validated in a cross-sectional study. In a quasi-experimental study, the impact of UTI risk assessment was investigated by evaluating changes in the behaviour of clinicians, measuring changes in antibiotic prescriptions and urine culture requests.

Results

First, we trained and tested two different predictive models with 8692 cases. Second, we investigated the performance of the predictive models in clinical practice with 962 cases (Area under the curve was between 0.81 to 0.88). The best performance was the combination of both models. Finally, the assessment of the risk for UTIs was implemented into clinical practice and allowed for the reduction of unnecessary urine cultures and antibiotic prescriptions for patients with a low risk of UTI, as well as targeted diagnostics and treatment for patients with a high risk of UTI.

Conclusion

The combination of modern urinalysis diagnostic technologies with digital health solutions can help to further improve UTI diagnostics with positive impact on laboratory workloads and antimicrobial stewardship.

Isolation, Characterization, and Unlocking the Potential of Mimir124 Phage for Personalized Treatment of Difficult, Multidrug-Resistant Uropathogenic E. coli Strain

Escherichia coli and its bacteriophages are among the most studied model microorganisms. Bacteriophages for various E. coli strains can typically be easily isolated from environmental sources, and many of these viruses can be harnessed to combat E. coli infections in humans and animals. However, some relatively rare E. coli strains pose significant challenges in finding suitable phages. The uropathogenic strain E. coli UPEC124, isolated from a patient suffering from neurogenic bladder dysfunction, was found to be resistant to all coliphages in our collections, and initial attempts to isolate new phages failed. Using an improved procedure for phage enrichment, we isolated the N4-related phage Mimir124, belonging to the Gamaleyavirus genus, which was able to lyse this "difficult" E. coli strain. Although Mimir124 is a narrow-spectrum phage, it was effective in the individualized treatment of the patient, leading to pathogen eradication. The primary receptor of Mimir124 was the O antigen of the O101 type; consequently, Mimir124-resistant clones were rough (having lost the O antigen). These clones, however, gained sensitivity to some phages that recognize outer membrane proteins as receptors. Despite the presence of nine potential antiviral systems in the genome of the UPEC124 strain, the difficulty in finding effective phages was largely due to the efficient, non-specific cell surface protection provided by the O antigen. These results highlight the importance of an individualized approach to phage therapy, where narrow host-range phages-typically avoided in pre-fabricated phage cocktails-may be instrumental. Furthermore, this study illustrates how integrating genomic, structural, and functional insights can guide the development of innovative therapeutic strategies, paving the way for broader applications of phage therapy in combating multidrug-resistant bacterial pathogens.

Manipulating the Gut Microbiome in Urinary Tract Infection-Prone Patients

Although antibiotics remain the mainstay of urinary tract infection treatment, many affected women can be caught in a vicious cycle in which antibiotics given to eradicate one infection predispose them to develop another. This effect is primarily mediated by disturbances in the gut microbiome that both directly enrich for uropathogenic overgrowth and induce systemic alterations in inflammation, tissue permeability, and metabolism that also decrease host resistance to infection recurrences. Here, we discuss nonantibiotic approaches to manipulating the gut microbiome to reverse the systemic consequences of antibiotics, including cranberry supplementation and other dietary approaches, probiotic administration, and fecal microbiota transplantation.

Culture and amplification-free nanopore sequencing for rapid detection of pathogens and antimicrobial resistance genes from urine

PURPOSE

Urinary Tract Infections (UTIs) are among the most prevalent infections globally. Every year, approximately 150 million people are diagnosed with UTIs worldwide. The current state-of-the-art diagnostic methods are culture-based and have a turnaround time of 2-4 days for pathogen identification and susceptibility testing.

METHODS

This study first establishes an optical density culture-based method for spiking healthy urine samples with the six most prevalent uropathogens. Urine samples were spiked at clinically significant concentrations of 103-105 CFU/ml. Three DNA extraction kits (BioStic, PowerFood, and Blood and Tissue) were investigated based on the DNA yield, average processing time, elution volume, and the average cost incurred per extraction. After DNA extraction, the samples were sequenced using MinION and Flongle flow cells.

RESULTS

The Blood and Tissue kit outperformed the other kits based on the investigated parameters. Using nanopore sequencing, all the pathogens and corresponding genes were only identified at a spike concentration of 105 CFU/ml, achieved after 10 min and 3 hours of sequencing, respectively. However, some pathogens and antibiotic-resistance genes (ARG) could be identified from spikes at 103 colony formation units (CFU/mL). The overall turnaround time was five hours, from sample preparation to sequencing-based identification of pathogen ID and antimicrobial resistance genes.

CONCLUSION

This study demonstrates excellent promise in reducing the time required for informed antibiotic administration from 48 to 72 h to five hours, thereby reducing the number of empirical doses and increasing the chance of saving lives.

Suppression of virulence factors of uropathogenic Escherichia coli by Trans-resveratrol and design of nanoemulgel

BACKGROUND

Development of multidrug resistance in Uropathogenic Escherichia coli (UPEC) makes treatment of Urinary Tract Infections (UTIs) a major challenge. This study was conducted to investigate the effect of trans-resveratrol (t-RSV) at a subinhibitory concentration (sub-MIC-t-RSV) on phenotypic and genotypic expression of virulence factors of clinical isolates of UPEC and develop a nanoformulation of t-RSV. Fifty-five clinical UPEC strains were investigated for the presence of virulence factors by phenotypic methods and PCR detection of virulence genes. The effect of sub-MIC-t-RSV was studied on the phenotypic and genotypic expression of virulence factors. t-RSV-loaded nanoemulgel formulation was prepared and characterized.

RESULTS

Out of the 55 tested isolates, 50.9% were biofilm producers, 23.6% showed both mannose-sensitive and mannose-resistant hemagglutination, 21.8% were serum-resistant, 18.2% were hemolysin producers, while 36.4% showed cytotoxic effect on HEp-2 cells. A total of 25.5% of the isolates harbor one or more of hly-A, cnf-1 and papC genes, while 54.5% were positive for one or more of fimH, iss and BssS genes. A concentration of 100 µg/mL of t-RSV effectively downregulates the phenotypic and genotypic expression of the virulence factors in positive isolates. A stable t-RSV-nanaoemulgel with droplet size of 180.3 nm and Zetapotential of -46.9 mV was obtained.

CONCLUSION

The study proves the effective role of t-RSV as an antivirulence agent against clinical UPEC isolates in vitro and develops a stable t-RSV-nanoemulgel formulation to be assessed in vivo. The promising antibacterial and antivirulence properties of t-RSV place this natural compound to be a better alternative in the treatment of persistent UTIs.

Economic Burden of Community-Acquired Antibiotic-Resistant Urinary Tract Infections: Systematic Review and Meta-Analysis

Background

Antibiotic resistance (ABR) poses a major burden to global health and economic systems. ABR in community-acquired urinary tract infections (CA-UTIs) has become increasingly prevalent. Accurate estimates of ABR's clinical and economic burden are needed to support medical resource prioritization and cost-effectiveness evaluations of urinary tract infection (UTI) interventions.

Objective

This study aims to systematically synthesize the evidence on the economic costs associated with ABR in CA-UTIs, using published studies comparing the costs of antibiotic-susceptible and antibiotic-resistant cases.

Methods

We searched the PubMed, Ovid MEDLINE and Embase, Cochrane Review Library, and Scopus databases. Studies published in English from January 1, 2008, to January 31, 2023, reporting the economic costs of ABR in CA-UTI of any microbe were included. Independent screening of titles/abstracts and full texts was performed based on prespecified criteria. A quality assessment was performed using the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool. Data in UTI diagnosis criteria, patient characteristics, perspectives, resource costs, and patient and health economic outcomes, including mortality, hospital length of stay (LOS), and costs, were extracted and analyzed. Monetary costs were converted into 2023 US dollars.

Results

This review included 15 studies with a total of 57,251 CA-UTI cases. All studies were from high- or upper-middle-income countries. A total of 14 (93%) studies took a health system perspective, 13 (87%) focused on hospitalized patients, and 14 (93%) reported UTI pathogens. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are the most prevalent organisms. A total of 12 (80%) studies reported mortality, of which, 7 reported increased mortality in the ABR group. Random effects meta-analyses estimated an odds ratio of 1.50 (95% CI 1.29-1.74) in the ABR CA-UTI cases. All 13 hospital-based studies reported LOS, of which, 11 reported significantly higher LOS in the ABR group. The meta-analysis of the reported median LOS estimated a pooled excess LOS ranging from 1.50 days (95% CI 0.71-4.00) to 2.00 days (95% CI 0.85-3.15). The meta-analysis of the reported mean LOS estimated a pooled excess LOS of 2.45 days (95% CI 0.51-4.39). A total of 8 (53%) studies reported costs in monetary terms-none discounted the costs. All 8 studies reported higher medical costs spent treating patients with ABR CA-UTI in hospitals. The highest excess cost was observed in UTIs caused by carbapenem-resistant Enterobacterales. No meta-analysis was performed for monetary costs due to heterogeneity.

Conclusions

ABR was attributed to increased mortality, hospital LOS, and economic costs among patients with CA-UTI. The findings of this review highlighted the scarcity of research in this area, particularly in patient morbidity and chronic sequelae and costs incurred in community health care. Future research calls for a cost-of-illness analysis of infections, standardizing therapy-pathogen combination comparators, medical resources, productivity loss, intangible costs to be captured, and data from community sectors and low-resource settings and countries.

The epidemiology of gram-negative bacteremia in Lebanon: a study in four hospitals

INTRODUCTION

Gram-negative bacteremia is a life-threatening infection with high morbidity and mortality. Its incidence is rising worldwide, and treatment has become more challenging due to emerging bacterial resistance. Little data is available on the burden and outcome of such infections in Lebanon.

METHODS

We conducted this retrospective study in four Lebanese hospitals. Data on medical conditions and demographics of 2400 patients diagnosed with a bloodstream infection based on a positive blood culture were collected between January 2014 and December 2020.

RESULTS

Most bacteremias were caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, with the more resistant organisms being hospital-acquired. Third-generation cephalosporin and quinolone resistance was steady throughout the study, but carbapenem resistance increased. Mortality with such infections is high, but carbapenem resistance or infection with Pseudomonas or Acinetobacter species were significant risk factors for poor outcomes.

CONCLUSION

This is the first multi-center study from Lebanon on gram-negative bacteremia, resistance patterns, and factors associated with a poor outcome. More surveillance is needed to provide data to guide empirical treatment for bacteremia in Lebanon.

Prevalence and risk factors of antibiotic resistance for urinary tract infections in patients presenting to a Belgian tertiary care emergency department: testing the national guidelines against the local setting

OBJECTIVES

Urinary tract infections (UTIs) are an important cause of empiric antibiotic (over)treatment at the emergency department (ED). To enhance empiric antibiotic choices, mapping the national and local microbiology and antimicrobial resistance (AMR) patterns is crucial. This study aims to examine resistance patterns at a Brussels ED and to identify risk factors for AMR to evaluate current treatment guidelines and help combat AMR.

METHODS

Adult patients undergoing urinalysis at the ED of a Brussels tertiary care hospital with positive urine cultures were included. Descriptive microbiological mapping of UTI or asymptomatic bacteriuria (ASB) micro-organisms was performed. Potential risk factors of antibiotic resistance in Gram-negative bacteria were assessed by using logistic regression analysis.

RESULTS

Out of 96 patients with Gram-negative bacteria in urinary culture, the predominant uropathogen was Escherichia coli (58.3%), with 8.6% being extended spectrum beta-lactamase (ESBL)-producing strains. Overall, fosfomycin (29.2%) and nitrofurantoin (28.6%) showed the highest resistance rates. Ceftriaxone revealed lower resistance rates (13.1%) compared to ciprofloxacin (17.0%) and cefuroxime (18.4%). Temocillin exhibited the lowest resistance rate (8.2%) especially against ESBLs (0%). Ciprofloxacin resistance increased with age (OR 1.05 [1.01-1.10]) and recurrent UTIs (OR 4.79 [1.18-19.42]). Male gender was associated with higher odds of temocillin resistance (OR 5.79 [1.18-28.34]).

CONCLUSION

In the studied Belgian ED setting, ceftriaxone seems slightly safer than ciprofloxacin, especially for recurrent UTI patients. However, overall, and especially in patients at risk for ESBL-producing bacteria, temocillin would be an even better choice in our setting. National microbiological data should be reviewed to support recommending temocillin as a first-line antibiotic in patients presenting with upper UTI.

Investigating trends in antibiotic resistance of Escherichia coli isolated from clinical urine specimens in the Orkney Islands

Urinary tract infections (UTIs) are extremely common, affecting people of all ages and health statuses. Although UTIs do not usually cause severe illness, in some cases they can lead to more serious complications, especially if their initial treatment is ineffective due to antimicrobial resistance (AMR). AMR is an increasing issue, exacerbated by misdiagnosis and inappropriate prescribing of antibiotics, thus facilitating further resistance. The aim of this study was to investigate the rates of AMR in Escherichia coli isolated from clinical urine specimens tested at the Balfour Hospital, Orkney, and determine trends related to patient risk factors. Antibiotic susceptibilities were tested for 100 isolates of uropathogenic E. coli using the VITEK 2 Compact (bioMérieux), and data were analysed using percentage resistance rates. Resistance rates were compared by patient sex, age and source (hospital versus community). The findings showed higher AMR in males compared with females, particularly for trimethoprim (TMP), with 52% in males and only 12% in females. AMR tended to be higher in E. coli isolated from hospital inpatients than from community specimens, except for amoxicillin (AMX) and co-amoxiclav. Finally, the study found that AMR of E. coli isolates was greater in patients aged over 50 than 18-50 years old, particularly for AMX and TMP. The highest resistance rates across all patient demographics were for AMX, implying that the use of this antibiotic for the treatment of E. coli UTIs is not appropriate.

Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management

Urinary tract infections (UTIs) are the second most common infectious disease, predominantly impacting women with 150 million individuals affected globally. It increases the socio-economic burden of society and is mainly caused by Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter spp., and Staphylococcus spp. The severity of the infection correlates with the host factors varying from acute to chronic infections. Even with a high incidence rate, the diagnosis is mainly based on the symptoms, dipstick analysis, and culture analysis, which are time-consuming, labour-intensive, and lacking sensitivity and specificity. During this period, medical professionals prescribe empirical antibiotics, which may increase the antimicrobial resistance rate. Timely and precise UTI diagnosis is essential for addressing antibiotic resistance and improving overall quality of life. In response to these challenges, new techniques are emerging. The review provides a comprehensive overview of the global burden of UTIs, associated risk factors, implicated organisms, traditional and innovative diagnostic methods, and approaches to UTI treatment and prevention.

Field-Deployable Colorimetric Array for On-Site Diagnosis of Urinary Tract Infection and Identification of Causative Pathogens

Urinary tract infection (UTI) is a common and prevalent disease caused by a spectrum of pathogens. Lack of access to rapid, portable, and high-quality diagnostics in resource-limited settings aggravates the improper treatment of UTIs, which is also a major driver of antibiotic misuse worldwide. Here, we describe a custom-made portable colorimetric array (PoCA) for reading out polymerase chain reaction (PCR) amplicons, the rationale of which is to transfer the previously developed dsDNA-based photosensitization colorimetric assay (solution) onto paper discs for detection. By integrating mini-LED irradiation and paper discs, the PoCA can read out 96 PCR tests in one pot, thus allowing diagnosis and identification of 12 prevailing UTI pathogens in less than 2 h, coupled with a portable thermal cycler for PCR. After analyzing 200 clinical urine samples, the pathogen profiling accuracy of the PoCA was demonstrated to be higher than the standard urine culture (confirmed with metagenomic next-generation sequencing). The PoCA platform could be used in primary care for rapid UTI diagnosis and pathogen identification.

Plastic induced urinary tract disease and dysfunction: a scoping review

INTRODUCTION

In 2019 the World Health Organisation published a report which concluded microplastics in drinking water did not present a threat to human health. Since this time a plethora of research has emerged demonstrating the presence of plastic in various organ systems and their deleterious pathophysiological effects.

METHODS

A scoping review was undertaken in line with recommendations from the Johanna Briggs Institute. Five databases (PubMed, SCOPUS, CINAHL, Web of Science and EMBASE) were systematically searched in addition to a further grey literature search.

RESULTS

Eighteen articles were identified, six of which investigated and characterised the presence of microplastics and nanoplastics (MNPs) in the human urinary tract. Microplastics were found to be present in kidney, urine and bladder cancer samples. Twelve articles investigated the effect of MNPs on human cell lines associated with the human urinary tract. These articles suggest MNPs have a cytotoxic effect, increase inflammation, decrease cell viability and alter mitogen-activated protein kinases (MAPK) signalling pathways.

CONCLUSION

Given the reported presence MNPs in human tissues and organs, these plastics may have potential health implications in bladder disease and dysfunction. As a result, institutions such as the World Health Organisation need to urgently re-evaluate their position on the threat of microplastics to public health.

IMPACT STATEMENT

This scoping review highlights the rapidly emerging threat of microplastic contamination within the human urinary tract, challenging the World Health Organisation's assertion that microplastics pose no risk to public health. The documented cytotoxic effects of microplastics, alongside their ability to induce inflammation, reduce cell viability and disrupt signalling pathways, raise significant public health concerns relating to bladder cancer, chronic kidney disease, chronic urinary tract infections and incontinence. As a result, this study emphasises the pressing need for further research and policy development to address the challenges surrounding microplastic contamination.