Emerging Non-Antibiotic Options Targeting Uropathogenic Mechanisms for Recurrent Uncomplicated Urinary Tract Infection

Abstract

Urinary tract infections (UTIs) are the most frequent bacterial infections in the clinical setting. Even without underlying anatomic or functional abnormalities, more than 40% of women experience at least one UTI in their lifetime, of which 30% develop recurrent UTIs (rUTIs) within 6 months. Conventional management with antibiotics for rUTIs may eventually lead to the development of multidrug-resistant uropathogens. Targeting of the pathogenicity of rUTIs, the evolution of uropathogenic Escherichia coli (UPEC), and inadequate host defenses by immune responses should be explored to provide non-antibiotic solutions for the management of rUTIs. The adaptive evolution of UPEC has been observed in several aspects, including colonization, attachment, invasion, and intracellular replication to invade the urothelium and survive intracellularly. Focusing on the antivirulence of UPEC and modulating the immunity of susceptible persons, researchers have provided potential alternative solutions in four categories: antiadhesive treatments (i.e., cranberries and D-mannose), immunomodulation therapies, vaccines, and prophylaxis with topical estrogen therapy and probiotics (e.g., Lactobacillus species). Combination therapies targeting multiple pathogenic mechanisms are expected to be a future trend in UTI management, although some of these treatment options have not been well established in terms of their long-term efficacy. Additional clinical trials are warranted to validate the therapeutic efficacy and durability of these techniques.

Hygiene management of intermittent self‐catheterization using reusable silicone catheters in people with spinal cord lesions: A cross‐sectional Internet survey in Japan

“…Moreover, 62 (45.6%) respondents kept antibiotics readily available to reduce the burden of clinic visits and hospitalization due to sUTI (Table 1), which contradicts the current antibiotic stewardship and raised the concerns about emergence of multi‐drug resistant bacteria. Therefore, in this regard, treatment options such as antiadhesive treatments (i.e., cranberries), immunomodulation therapies, and vaccines are expected in persons with CIC 20 . Further studies are warranted to establish a standardized catheter maintenance procedure, including other nonantibiotic strategies, for reusable catheters to prevent sUTI and adverse events.…”

“…Therefore, in this regard, treatment options such as antiadhesive treatments (i.e., cranberries), immunomodulation therapies, and vaccines are expected in persons with CIC. 20 Further studies are warranted to establish a standardized catheter maintenance procedure, including other nonantibiotic strategies, for reusable catheters to prevent sUTI and adverse events.…”

What to do about recurrent urinary tract infections: A review of evidence behind emerging therapies

“…1 Recurrent UTIs (rUTIs) are defined as two or more episodes of uncomplicated UTI in the preceding six months or three or more episodes diagnosed over one year. [2][3][4][5][6] Pregnant patients are considered to have rUTIs if they have two or more episodes of UTIs during their pregnancy. 7 rUTIs can impact a patient's quality of life, as persistent symptoms can be debilitating and is a risk factor for antimicrobial resistance and severe infections.…”

“…7 rUTIs can impact a patient's quality of life, as persistent symptoms can be debilitating and is a risk factor for antimicrobial resistance and severe infections. 3,4,6 The pathophysiology of rUTIs includes bacterial persistence or bacterial reinfection. New infections with the same organism refer to infection persistence, often due to inadequate initial treatment of ongoing nidus of infection.…”

Effect of DMPEI coating against biofilm formation on PVC catheter surface

“…Bio lms can be formed in 24h, inducting infections fast (Chadha et al 2023). The most common microorganisms found in CAUTI are uropathogenic Escherichia coli, responsible for 80% of cases (Chen et al 2023), followed by Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (Medina and Castillo-Pino 2019; Klein and Hultgren 2020).…”