New paradigms of urinary tract infections: Implications for patient management

Abstract

Urinary tract infections (UTIs) represent one of the most commonly acquired diseases among the general population as well as hospital in-patients, yet remain difficult to effectively and consistently treat. High rates of recurrence, anatomic abnormalities, and functional disturbances of the urinary tract all contribute to the difficulty in management of these infections. However, recent advances reveal important molecular and genetic factors that contribute to bacterial invasion and persistence in the urinary tract, particularly for the most common causative agent, uropathogenic Escherichia coli. Recent studies using animal models of experimental UTIs have recently provided mechanistic insight into the clinical observations that question the effectiveness of antibiotic therapy in treatment. Ultimately, continuing research will be necessary to identify the best targets for effective treatment of this costly and widespread infectious disease.

Keywords: Escherichia coli; epidemiology; urinary tract infection.

Figure 1

Intracellular lifestyle of UPEC. The cartoon depicts the stages through which UPEC (blue and green) proceeds during infection of superficial bladder epithelial cells (SBECs). The intracellular residence protects from polymorphonuclear leukocyte (PMN) attack. See text for details