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The Role of Gram-Negative Bacteria in Urinary Tract Infections: Current Concepts and Therapeutic Options

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Advances in Microbiology, Infectious Diseases and Public Health

Part of the book series: Advances in Experimental Medicine and Biology ((AMIDPH,volume 1323))

Abstract

Urinary tract infections (UTIs) are some of the most common infections in human medicine worldwide, recognized as an important public health concern to healthcare systems around the globe. In addition, urine specimens are one of the most frequently submitted samples for culture to the clinical microbiology laboratory, exceeding the number of most of the other sample types. The epidemiology, species-distribution and susceptibility-patterns of uropathogens vary greatly in a geographical and time-dependent manner and it also strongly correlated with the reported patient population studied. Nevertheless, many studies highlight the fact that the etiological agents in UTIs have changed considerably, both in nosocomial and community settings, with a shift towards “less common” microorganisms having more pronounced roles. There is increasing demand for further research to advance diagnostics and treatment options, and to improve care of the patients. The aim of this review paper was to summarize current developments in the global burden of UTI, the diagnostic aspects of these infectious pathologies, the possible etiological agents and their virulence determinants (with a special focus on the members of the Enterobacterales order), current guidelines and quality indicators in the therapy of UTIs and the emergence of multidrug resistance in urinary pathogens.

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Abbreviations

ACSS:

Acute Cystitis Symptom Score

AP:

acute pyelonephritis

ASB:

asymptomatic bacteriuria

AUC:

acute uncomplicated cystitis

CAUTI:

catheter-associated UTI

CDC:

Centers for Disease Control

CFU:

colony-forming units

CRGNB:

carbapenem-resistant Gram-negative bacilli

cUTI:

complicated UTI

ECDC:

European Centre for Disease Prevention and Control

ESBL:

extended-spectrum β-lactamase

ExPEC:

extra-intestinal pathogenic Escherichia coli

GNB:

Gram-negative bacteria

ICE:

integrative and conjugative element

IDSA:

Infectious Diseases Society of America

InCOM:

intra-intestinal commensal

InPEC:

intra-intestinal pathogenic Escherichia coli

LPS:

lipopolysaccharide

m/z:

mass-to-charge

MALDI-TOF MS:

matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

MDR:

multidrug-resistant

MRSA:

methicillin-resistant Staphylococcus aureus

MRSA:

methicillin-resistant Staphylococcus epidermidis

MRSE:

methicillin-resistant Staphylococcus epidermidis

MSSA:

methicillin-sensitive Staphylococcus aureus

NACA:

non-albicans Candida

NECE:

non-E. coli Enterobacterales

NGS:

next-generation sequencing

NICE:

The National Institute for Health and Care Excellence

OMP:

outer membrane proteins

OMV:

outer membrane vesicles

PAI:

pathogenicity islands

PCR:

polymerase chain-reaction

PDR:

pandrug-resistant

PROM:

patient-reported outcome measures

QI:

quality indicator

QoL:

quality of life

rRNA:

ribosomal RNA

RTX:

repeats in toxin

rUTI:

recurrent UTI

ShiToPInPEC:

Shigella Toxin Producer InPEC

TMP/SMX:

trimethoprim-sulfamethoxazole

UPCA:

uropathogenic Candida albicans

UPEC:

uropathogenic Escherichia coli

US:

United States

UTI:

urinary tract infections

VF:

virulence factors

VRE:

vankomycin-resistant Enterococcus

WHO:

World Health Organization

XDR:

extensively drug resistant

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The authors declare no conflict of interest, monetary or otherwise. The authors alone are responsible for the content and writing of this article.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. M.G. was supported by the National Youth Excellence Scholarship (Grant Number NTP-NTFÖ-18-C-0225) and ESCMID’s “30 under 30” Award.

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Authors and Affiliations

  1. Department of Microbiology, College of Basic Sciences Islamic Azad University, Tehran, Iran

    Payam Behzadi

  2. Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary

    Edit Urbán

  3. Institute of Translational Medicine, University of Pécs, Medical School, Pécs, Hungary

    Edit Urbán

  4. Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary

    Mária Matuz & Ria Benkő

  5. Central Pharmacy Service, Emergency Department, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary

    Ria Benkő

  6. Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary

    Márió Gajdács

  7. Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary

    Márió Gajdács

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    Gianfranco Donelli

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Behzadi, P., Urbán, E., Matuz, M., Benkő, R., Gajdács, M. (2020). The Role of Gram-Negative Bacteria in Urinary Tract Infections: Current Concepts and Therapeutic Options. In: Donelli, G. (eds) Advances in Microbiology, Infectious Diseases and Public Health. Advances in Experimental Medicine and Biology(), vol 1323. Springer, Cham. https://doi.org/10.1007/5584_2020_566

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