The global burden of antimicrobial resistance - urinary tract infections

Nephrol Dial Transplant. 2023 Oct 27:gfad233. doi: 10.1093/ndt/gfad233. Online ahead of print.


Antimicrobial resistance (AMR) emerged as a significant global healthcare problem. Antibiotic use has accelerated the physiologic process of AMR, particularly in Gram-negative pathogens. Urinary tract infections (UTI) are predominantly of Gram-negative nature. Uropathogens are evolutionarily highly adapted and selected strains with specific virulence factors, suggesting common mechanisms how bacterial cells acquire virulence and AMR factors. The simultaneous increase in resistance and virulence is a complex and context-dependent phenomenon. Amongst known AMR mechanisms, the plenitude of different β-lactamases is especially prominent. The risk for AMR in UTI varies in different patient populations. History of antibiotic consumption and physiology of urinary flow are major factors that shape AMR prevalence. The urinary tract is in close crosstalk with the microbiome of other compartments, such as the gut or the genital tracts. In addition, pharmacokinetic properties and the physiochemical composition of urinary compartments can contribute to emergence of AMR. Alternatives to antibiotic treatment and a broader approach to address bacterial infections are needed. Among the various alternatives studied, antimicrobial peptides (AMPs) and bacteriophage treatment appear to be highly promising approaches. We here summarize the present knowledge of clinical and microbiological AMR in UTI and discuss innovative approaches, namely new risk prediction tools and the use of non-antibiotic approaches to defend against uropathogenic microbes.

Keywords: antimicrobial peptides; antimicrobial resistance; evolution; patient population; urinary tract infections.