pp 1-35 | Cite as

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

  • Payam Behzadi
  • Edit Urbán
  • Mária Matuz
  • Ria Benkő
  • Márió GajdácsEmail author
Part of the Advances in Experimental Medicine and Biology book series


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.


Antibiotics Clinical microbiology’ virulence Epidemiology Escherichia coli Multidrug resistance Pathogenomics Therapeutic guidelines Urinary tract infections 



Acute Cystitis Symptom Score


acute pyelonephritis


asymptomatic bacteriuria


acute uncomplicated cystitis


catheter-associated UTI


Centers for Disease Control


colony-forming units


carbapenem-resistant Gram-negative bacilli


complicated UTI


European Centre for Disease Prevention and Control


extended-spectrum β-lactamase


extra-intestinal pathogenic Escherichia coli


Gram-negative bacteria


integrative and conjugative element


Infectious Diseases Society of America


intra-intestinal commensal


intra-intestinal pathogenic Escherichia coli






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




methicillin-resistant Staphylococcus aureus


methicillin-resistant Staphylococcus epidermidis


methicillin-resistant Staphylococcus epidermidis


methicillin-sensitive Staphylococcus aureus


non-albicans Candida


non-E. coli Enterobacterales


next-generation sequencing


The National Institute for Health and Care Excellence


outer membrane proteins


outer membrane vesicles


pathogenicity islands


polymerase chain-reaction




patient-reported outcome measures


quality indicator


quality of life


ribosomal RNA


repeats in toxin


recurrent UTI


Shigella Toxin Producer InPEC




uropathogenic Candida albicans


uropathogenic Escherichia coli


United States


urinary tract infections


virulence factors


vankomycin-resistant Enterococcus


World Health Organization


extensively drug resistant




Conflict of Interest

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


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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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Payam Behzadi
    • 1
  • Edit Urbán
    • 2
    • 3
  • Mária Matuz
    • 4
  • Ria Benkő
    • 4
    • 5
  • Márió Gajdács
    • 6
    • 7
    Email author
  1. 1.Department of MicrobiologyCollege of Basic Sciences Islamic Azad UniversityTehranIran
  2. 2.Department of Public Health, Faculty of MedicineUniversity of SzegedSzegedHungary
  3. 3.Institute of Translational MedicineUniversity of Pécs, Medical SchoolPécsHungary
  4. 4.Department of Clinical Pharmacy, Faculty of PharmacyUniversity of SzegedSzegedHungary
  5. 5.Central Pharmacy Service, Emergency Department, Albert Szent-Györgyi Clinical CenterUniversity of SzegedSzegedHungary
  6. 6.Institute of Medical Microbiology, Faculty of MedicineSemmelweis UniversityBudapestHungary
  7. 7.Department of Pharmacodynamics and Biopharmacy, Faculty of PharmacyUniversity of SzegedSzegedHungary

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