Uropathogenic Escherichia coli in Recurrent Urinary Tract Infection: Intracellular Persistence, Immune Evasion, Antimicrobial Resistance, and Non-Antibiotic Interventions
Abstract
Uropathogenic Escherichia coli (UPEC) remains the principal driver of urinary tract infections (UTIs), utilizing sophisticated immunoevasive strategies that consistently outmaneuver host defenses and conventional clinical management. This review synthesizes current evidence highlighting the development of recurrent UTIs (rUTIs). Particular emphasis is given to the transition of UPEC into intracellular bacterial communities (IBCs) and quiescent intracellular reservoirs (QIRs)-survival phenomena primarily characterized across specialized mammalian and cellular models. By highlighting the translational evidence gaps surrounding these intracellular sanctuaries, and the challenge of directly extrapolating these model-derived dynamics to human recurrent UTIs (rUTIs), alongside the role of extra-urinary niches, we provide a comprehensive view of the mechanisms driving recurrence. A critical assessment of the UPEC virulence arsenal, involving molecular mechanisms that regulate fimbrial phase variation resulting in evading host immune surveillance, to specialized adhesins, like FimH, which tightly bind uroplakin receptors, triggering host actin rearrangements via rho-GTPase signaling and facilitating bacterial internalization, is also addressed. Additionally, we integrate the roles of cytotoxic necrotizing factor-1 (CNF1) and hemolysin A (HlyA) in promoting cytosolic escape, host cell survival, and long-term persistence. Finally, this review presents a multidisciplinary framework…
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.