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Current and emerging strategies to curb antibiotic-resistant urinary tract infections

Nature Reviews Urology (2024)Cite this article

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Abstract

Rising rates of antibiotic resistance in uropathogenic bacteria compromise patient outcomes and prolong hospital stays. Consequently, new strategies are needed to prevent and control the spread of antibiotic resistance in uropathogenic bacteria. Over the past two decades, sizeable clinical efforts and research advances have changed urinary tract infection (UTI) treatment and prevention strategies to conserve antibiotic use. The emergence of antimicrobial stewardship, policies from national societies, and the development of new antimicrobials have shaped modern UTI practices. Future UTI management practices could be driven by the evolution of antimicrobial stewardship, improved and readily available diagnostics, and an improved understanding of how the microbiome affects UTI. Forthcoming UTI treatment and prevention strategies could employ novel bactericidal compounds, combinations of new and classic antimicrobials that enhance bacterial killing, medications that prevent bacterial attachment to uroepithelial cells, repurposing drugs, and vaccines to curtail the rising rates of antibiotic resistance in uropathogenic bacteria and improve outcomes in people with UTI.

Key points

  • Uropathogenic Escherichia coli is the most common cause of urinary tract infections (UTIs), but up to 90% of E. coli strains worldwide are resistant to at least one antibiotic.

  • Global, regional and community programmes educating clinicians on the current states of antibiotic use and resistance, monitoring or guiding antibiotic use, expanding pathogen testing, and promoting vaccination could reduce the prevalence of antibiotic resistance in uropathogenic bacteria.

  • Antibiotic and diagnostic stewardship programmes have benefited UTI management by reducing antibiotic use, improving patient outcomes, minimizing health-care costs and decreasing the incidence of antibiotic-resistant uropathogens.

  • Translational research efforts are leading to the development of nanoparticles, antimicrobial peptides and small molecules as promising antibiotic-conserving therapies for UTIs.

  • Diverse and healthy gastrointestinal and genitourinary microbiomes might prevent UTI recurrence and identifying avenues to prevent their dysbiosis could reduce antibiotic use.

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Fig. 1: Relationship between diagnostic and antimicrobial stewardship.
Fig. 2: Antimicrobial synergy shows promise to reduce antibiotic use for urinary tract infection.
Fig. 3: The gastrointestinal and genitourinary microbiomes influence urinary tract infection susceptibility.

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Acknowledgements

C.B.C. and J.D.S. disclose support for publication of this work from the National Institutes of Health (NIDDK): K08 DK122119, R01 DK115737, DK114035 and DK128088.

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Authors and Affiliations

  1. The Kidney and Urinary Tract Center, Nationwide Children’s Abigail Wexner Research Institute, Columbus, OH, USA

    Aaron Simoni, Laura Schwartz, Christina B. Ching & John David Spencer

  2. Department of Pediatrics, Division of Nephrology and Hypertension, Nationwide Children’s, Columbus, OH, USA

    Laura Schwartz & John David Spencer

  3. The Ohio State University College of Medicine, Columbus, OH, USA

    Laura Schwartz & John David Spencer

  4. Department of Pediatrics, Division of Infectious Diseases, Nationwide Children’s, Columbus, OH, USA

    Guillermo Yepes Junquera

  5. Department of Urology, Nationwide Children’s, Columbus, OH, USA

    Christina B. Ching

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Simoni, A., Schwartz, L., Junquera, G.Y. et al. Current and emerging strategies to curb antibiotic-resistant urinary tract infections. Nat Rev Urol (2024). https://doi.org/10.1038/s41585-024-00877-9

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