Management of uncomplicated urinary tract infection in the post-antibiotic era: select non-antibiotic approaches

The natural immune molecules urinary Tamm-Horsfall protein and pentraxin 3 as predictors for recurrent urinary tract infection severity: a single-center self-control study

OBJECTIVE

The innate immune defense plays a pivotal role in protecting the urinary tract from uropathogenic invasion and maintaining immune homeostasis. Dysregulation of the innate immune system can result in recurrent urinary tract infections (RUTI) due to heightened susceptibility to uropathogens. Despite this, predicting the risk of recurrence and the degree of immune compromise in patients who have had one urinary tract infection remains challenging. Also identifying which patients are more susceptible to developing pyelonephritis rather than the more local disease of cystitis is imperfect, although delayed diagnosis of a UTI is a good indicator for developing pyelonephritis. This study aims to assess the potential of urinary Tamm-Horsfall protein (THP) and Pentraxin 3 (PTX3) as predictors of RUTI symptom severity and recurrence, while also evaluating the efficacy of the Chinese herbal formulation Tailin Formula (TLF) as a clinical therapeutic intervention for RUTI.

METHODS

A single-center cohort study was conducted involving 142 participants, consisting of 31 healthy individuals (non-RUTI group, n = 31) and 111 patients with RUTI. The RUTI patients were divided into two groups: one group received continuous low-dose antibiotic therapy (CLAT group, n = 55), and the other group received herbal preparations (Tailin formula) (TLF group, n = 56). All patients received consistent lifestyle guidance. Descriptive analysis was performed on the RUTI cohort.

RESULTS

Urinary THP levels were significantly lower in RUTI patients (TLF and CLAT groups) compared to the non-RUTI, whereas PTX3 levels showed a tendency toward elevation. After treatment, urinary THP levels were markedly higher in the TLF group (27.43 ± 7.07) compared to pretreatment levels (10.00 ± 2.79), while levels remained lower in the CLAT group (8.91 ± 2.23) than in the TLF group. Urinary PTX3 levels decreased post-treatment in both groups after treatment than before (CLAT: 0.30 ± 0.13 vs. 1.04 ± 0.38; TLF: 0.29 ± 0.12 vs. 1.15 ± 0.36). Additionally, THP was negatively correlated with renal tubular injury markers NAG/Cr and β2-MG in RUTI patients (r = -0.5041 and -0.6169, respectively), while PTX3 showed a positive correlation with NAG/Cr and β2-MG (r = 0.28 and 0.498, respectively). Notably, as RUTI symptoms improved and recurrence rates decreased, urinary THP levels increased, while PTX3 levels decreased.

CONCLUSION

This study suggests that urinary THP and PTX3 are likely involved in the pathogenesis of RUTI. These biomarkers may serve as valuable predictors for assessing symptom severity, recurrence risk, and therapeutic efficacy in patients with RUTI at risk of disease progression.

Ultrasound-activated inorganic nanomaterials to generate ROS for antibacterial applications

Given the global overuse and misuse of antibiotics, the problem of antibiotic resistance has become increasingly severe, necessitating the urgent development of innovative therapeutic strategies to address bacterial infections. In recent years, nanomaterial-mediated sonodynamic therapy (SDT) has emerged as a promising alternative treatment. This strategy works by generating reactive oxygen species (ROS) to inhibit or kill bacteria, thereby avoiding the risk of antibiotic resistance. This review explores the various mechanisms by which ROS exert antibacterial effects and examines the different methods of generating ROS. It provides an overview of the diverse nanomaterials applied in SDT in recent years, including two-dimensional materials, metal-organic frameworks (MOFs), heterojunctions, and surface-modified bulk materials. Additionally, it discusses other types of nanomaterials such as metal oxides and piezoelectric materials, while also highlighting their specific therapeutic applications in treating infections like skin infections and osteomyelitis. At the conclusion of the review, the development of nanomaterial-mediated SDT is discussed in terms of both its potential and challenges. The article offers valuable theoretical insights and practical references for the preparation of the nanomaterials required for this antibiotic-free therapeutic approach, and proposes new directions for future research aimed at addressing the growing issue of antibiotic resistance.

Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study

BACKGROUND

This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., and Morganella morganii (ESCPM).

METHODS

Data of 458 individuals with cUTI caused by cefoxitin-nonsusceptible [minimum inhibitory concentration (MIC) > 8 µg/mL] and cefepime-susceptible (MIC ≤ 2 µg/mL) ESCPM was acquired from four Chinese hospitals between 2010 and 2022 and were reviewed retrospectively.

RESULTS

125 and 333 patients received cefepime and carbapenems, respectively, as antimicrobial therapy. The 28-day treatment failure rate was 15.7% (72/458). The following factors were identified as independent predictors for 28-day therapy: age, cefepime MIC = 2 µg/mL, immunocompromised status, infection source control, appropriate empirical therapy, and days from illness onset to active therapy. In patients who required cefepime MIC ≤ 1 µg/mL, a multivariate logistic model indicated that cefepime was linked with a similar risk of 28-day treatment failure [odd ratio (OR) 1.791, 95% confidence interval (CI) 0.600-5.350, p = 0.296] compared with carbapenems after controlling these predictors. Compared with individuals with cefoxitin-nonsusceptible ESCPM, those with isolates of cefepime (MIC = 2 µg/mL) had an enhanced risk of 28-day treatment failure (OR = 2.579, 95% CI = 1.012-6.572, p = 0.047). A propensity score for treatment analysis validated this relationship.

CONCLUSIONS

The cefepime and carbapenem had comparable efficacy for treating cUTI caused by cefoxitin-nonsusceptible ESCPM organisms with cefepime MIC ≤ 1 µg/mL, whereas carbapenems are potentially more effective for isolates with cefepime MIC = 2 µg/mL.

Bacteriophage therapy for multidrug-resistant infections: current technologies and therapeutic approaches

Bacteriophage (phage) therapy has emerged as a promising solution to combat the growing crisis of multidrug-resistant (MDR) infections. There are several international centers actively engaged in implementation of phage therapy, and recent case series have reported encouraging success rates in patients receiving personalized, compassionate phage therapy for difficult-to-treat infections. Nonetheless, substantial hurdles remain in the way of more widespread adoption and more consistent success. This Review offers a comprehensive overview of current phage therapy technologies and therapeutic approaches. We first delineate the common steps in phage therapy development, from phage bank establishment to clinical administration, and examine the spectrum of therapeutic approaches, from personalized to fixed phage cocktails. Using the framework of a conventional drug development pipeline, we then identify critical knowledge gaps in areas such as cocktail design, formulation, pharmacology, and clinical trial design. We conclude that, while phage therapy holds promise, a structured drug development pipeline and sustained government support are crucial for widespread adoption of phage therapy for MDR infections.

Overcoming challenges in the management of recurrent urinary tract infections

INTRODUCTION

Urinary tract infection (UTI) is a major global health concern. While acute UTIs can usually be effectively treated, recurrent UTIs (rUTIs) impact patients for years, causing significant morbidity and can become refractory to front-line antibiotics.

AREAS COVERED

This review discusses the risk factors associated with rUTI, current rUTI treatment paradigms, prophylactic strategies, and challenges in rUTI diagnostics. We specifically discuss common risk factors for rUTI, including biological sex, age, menopause status, and diabetes mellitus. We also review recently available evidence for commonly used treatments, from oral antibiotic therapy to intravesical antimicrobials, electrofulguration of chronic cystitis, and the last-resort treatment, cystectomy. We discuss the most current literature evaluating prophylactic strategies for rUTI including long-term antibiotic prophylaxis, estrogen hormone therapy, and dietary supplements. Finally, we address the important role of UTI diagnostics in effective rUTI management and review the strengths and limitations of both current and emerging UTI diagnostic platforms as well as their ability to operate at point-of-care.

EXPERT OPINION

We discuss the current challenges faced by clinicians in managing rUTI in women and the steps that should be taken so that clinicians, scientists, and patients can work together to better understand the disease and develop better strategies for its management.

Predictive phage therapy for Escherichia coli urinary tract infections: Cocktail selection for therapy based on machine learning models

This study supports the development of predictive bacteriophage (phage) therapy: the concept of phage cocktail selection to treat a bacterial infection based on machine learning (ML) models. For this purpose, ML models were trained on thousands of measured interactions between a panel of phage and sequenced bacterial isolates. The concept was applied to Escherichia coli associated with urinary tract infections. This is an important common infection in humans and companion animals from which multidrug-resistant (MDR) bloodstream infections can originate. The global threat of MDR infection has reinvigorated international efforts into alternatives to antibiotics including phage therapy. E. coli exhibit extensive genome-level variation due to horizontal gene transfer via phage and plasmids. Associated with this, phage selection for E. coli is difficult as individual isolates can exhibit considerable variation in phage susceptibility due to differences in factors important to phage infection including phage receptor profiles and resistance mechanisms. The activity of 31 phage was measured on 314 isolates with growth curves in artificial urine. Random Forest models were built for each phage from bacterial genome features, and the more generalist phage, acting on over 20% of the bacterial population, exhibited F1 scores of >0.6 and could be used to predict phage cocktails effective against previously untested strains. The study demonstrates the potential of predictive ML models which integrate bacterial genomics with phage activity datasets allowing their use on data derived from direct sequencing of clinical samples to inform rapid and effective phage therapy.

Neuro-Urology and Biobanking: An Integrated Approach for Advancing Research and Improving Patient Care

Understanding the molecular mechanisms underlying neuro-urological disorders is crucial for the development of targeted therapeutic interventions. Through the establishment of comprehensive biobanks, researchers can collect and store various biological specimens, including urine, blood, tissue, and DNA samples, to study these mechanisms. In the context of neuro-urology, biobanking facilitates the identification of genetic variations, epigenetic modifications, and gene expression patterns associated with neurogenic lower urinary tract dysfunction. These conditions often present as symptoms of neurological diseases such as Alzheimer's disease, multiple sclerosis, Parkinson's disease, spinal cord injury, and many others. Biobanking of tissue specimens from such patients is essential to understand why these diseases cause the respective symptoms and what can be done to alleviate them. The utilization of high-throughput technologies, such as next-generation sequencing and gene expression profiling, enables researchers to explore the molecular landscape of these conditions in an unprecedented manner. The development of specific and reliable biomarkers resulting from these efforts may help in early detection, accurate diagnosis, and effective monitoring of neuro-urological conditions, leading to improved patient care and management. Furthermore, these biomarkers could potentially facilitate the monitoring of novel therapies currently under investigation in neuro-urological clinical trials. This comprehensive review explores the synergistic integration of neuro-urology and biobanking, with particular emphasis on the translation of biobanking approaches in molecular research in neuro-urology. We discuss the advantages of biobanking in neuro-urological studies, the types of specimens collected and their applications in translational research. Furthermore, we highlight the importance of standardization and quality assurance when collecting samples and discuss challenges that may compromise sample quality and impose limitations on their subsequent utilization. Finally, we give recommendations for sampling in multicenter studies, examine sustainability issues associated with biobanking, and provide future directions for this dynamic field.