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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
Chapter
Part of the Advances in Experimental Medicine and Biology book series

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.

Keywords

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

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

Notes

Acknowledgements

None.

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.

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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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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