The etiology of urinary tract infection: traditional and emerging pathogens

doi:10.1016/S0002-9343(02)01055-0

The American Journal of Medicine

Volume 113, Issue 1, Supplement 1, 8 July 2002, Pages 14-19

https://doi.org/10.1016/S0002-9343(02)01055-0 Get rights and content

Abstract

The microbial etiology of urinary infections has been regarded as well established and reasonably consistent. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%). Klebsiella, Enterobacter, and Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis.

The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. The etiology of UTI is also affected by underlying host factors that complicate UTI, such as age, diabetes, spinal cord injury, or catheterization. Consequently, complicated UTI has a more diverse etiology than uncomplicated UTI, and organisms that rarely cause disease in healthy patients can cause significant disease in hosts with anatomic, metabolic, or immunologic underlying disease. The majority of community-acquired symptomatic UTIs in elderly women are caused by E coli. However, gram-positive organisms are common, and polymicrobial infections account for up to 1 in 3 infections in the elderly. In comparison, the most common organisms isolated in children with uncomplicated UTI are Enterobacteriaceae. Etiologic pathogens associated with UTI among patients with diabetes include Klebsiella spp., Group B streptococci, and Enterococcus spp., as well as E coli. Patients with spinal cord injuries commonly have E coli infections. Other common uropathogens include Pseudomonas and Proteus mirabilis.

Recent advances in molecular biology may facilitate the identification of new etiologic agents for UTI. The need for accurate and updated population surveillance data is apparent, particularly in light of concerns regarding antimicrobial resistance. This information will directly affect selection of empiric therapy for UTI.

Section snippets

Uncomplicated urinary tract infections

The etiology of uncomplicated UTIs has generally remained constant over the past 2 decades, albeit with a noticeable increase in antimicrobial resistance in both community-acquired and nosocomial UTIs. The etiology of complicated UTI is more diverse and directly affected by underlying host characteristics than that of uncomplicated UTI.

The majority of acute community-acquired, uncomplicated infections in the United States and abroad are caused by E coli (80%) or Staphylococcus saprophyticus

Overview

Underlying host factors, including age, diabetes, spinal cord injury, or catheterization, have a significant impact on the etiology of UTIs. Less virulent organisms that rarely cause disease in an anatomically or metabolically normal urinary tract can cause significant illness and invasive disease in an abnormal urinary tract. In addition, research in Spain has identified an increase in group B streptococcal bacteremia in nonpregnant adults during the 1985–1994 time period, particularly among

Pathogenesis of UTI

Individual susceptibility to UTI is complex, depending on genetic, biologic, and behavioral factors (Table 2). The interaction between bacterial virulence and host defense factors can ultimately result in UTI. Each bacterial species has distinct pathogenic mechanisms that facilitate UTI. Colonization is determined by the specific bacterial adhesive characteristics, the receptor repertoire on the epithelial surface, and the surrounding fluids. Vaginal colonization of uropathogens frequently

Conclusions

The majority of UTIs are uncomplicated infections. UTIs are considered complicated when patients have functional, metabolic, or structural abnormalities. Throughout the recent past, the most common causative pathogens associated with uncomplicated cystitis or acute pyelonephritis have been, and remain, E coli (80%) and S saprophyticus (5% to 15%). In comparison, the etiology of complicated UTI is more diverse and frequently polymicrobial in nature. Specific host factors, such as the extremes of

References (35)

A.R. Ronald et al.
Urinary tract infection in adultsresearch priorities and strategies
Int J Antimicrob Agents
(2001)
T.M. Hooton
Practice guidelines for urinary tract infections in the era of managed care
Int J Antimicrob Agents
(1999)
T.M. Hooton et al.
Diagnosis and treatment of uncomplicated urinary tract infection
Infect Dis Clin North Am
(1997)
J.M. McCarty et al.
A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in womenCiprofloxacin Urinary Tract Infection Group
Am J Med
(1999)
J.M. Langley et al.
Unique epidemiology of nosocomial urinary tract infection in children
Am J Infect Control
(2001)
P.W. Smith et al.
Microbiologic survey of long-term care facilities
Am J Infect Control
(2000)
A. Ronald et al.
Urinary tract infections in adults with diabetes
Int J Antimicrob Agents
(2001)
C. Coker et al.
Pathogenesis of Proteus mirabilis urinary tract infection
Microbes Infect
(2000)
D.A. Bronsema et al.
Secular trends in rates and etiology of nosocomial urinary tract infections at a university hospital
J Urol
(1993)
A.J. Schaeffer et al.
Host pathogenesis in urinary tract infections
Int J Antimicrob Agents
(2001)

A. Stapleton

Prevention of recurrent urinary-tract infections in women

Lancet

(1999)

T.A. Stamey et al.

The role of vaginal colonization with Enterobacteriaceae in recurrent urinary tract infections

J Urol

(1975)

T.A. Stamey et al.

Studies of introital colonization in women with recurrent urinary infections. 1. The role of vaginal pH

J Urol

(1975)

A. Brauner et al.

P-fimbriation and haemolysin production are the most important virulence factors in diabetic patients with Escherichia coli bacteraemiaa multivariate statistical analysis of seven bacterial virulence factors

J Infect

(1995)

W.E. Stamm et al.

Management of urinary tract infections in adults

N Engl J Med

(1993)

J.D. Sobel et al.

Candiduriaa randomized, double-blind study of treatment with fluconazole and placebo

Clin Infect Dis

(2000)

K. Gupta et al.

Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women

JAMA

(1999)

Cited by (475)

Click chemistry inspired facile one-pot synthesis of mannosyl triazoles and their hemagglutination inhibitory properties: The effect of alkyl chain spacer length between the triazole and phthalimide moieties in the aglycone backbone
2023, Carbohydrate Research
An efficient one-pot synthesis of a new series of mannosyl triazoles has been achieved through CuAAC reaction where the alkyl chain spacer between the phthalimide moiety and the triazole ring in the aglycone backbone is varied from one methylene to six methylene units. The target compounds were evaluated in terms of their inhibitory potency against FimH using hemagglutination inhibition (HAI) assay. It was found that the length of four methylene units was the optimum for the fitting/binding of the compound to FimH as exemplified by compound 11 (HAI = 1.9 μM), which was approximately 200 times more potent than the reference ligand 1(HAI = 385 μM). The successful implementation of one-pot protocol with building blocks 1-7 and the architecture of ligand 11 will be the subject of our future work for developing more potent FimH inhibitors.
Determinants of neonatal sepsis among neonates admitted to neonatal intensive care units in ethiopian hospitals: A systematic review and meta-analysis
2023, Heliyon
Several studies have identified risk factors for neonatal sepsis, but they are limited to specific geographical areas with results that may not be generalizable to other populations. Hence, the objective of this study was to determine the contributing factors, representative at a national level, that influence the occurrence of neonatal sepsis in neonates receiving hospital care in Ethiopia.
A thorough search was conducted across PubMed/Medline, Hinari, Cochrane Library, and Google Scholar to identify relevant studies. The pooled odds ratio was estimated using the random effect model. The heterogeneity among the included studies was evaluated using the I2 and Cochrane Q-statistics tests. Egger's tests used to assess publication bias.
A total of 19 studies comprising 6190 study participants were included. Neonatal sepsis was positively associated with several factors, namely: prolonged premature rupture of membrane (OR: 3.85, 95% CI: 2.31–6.42), low first minute APGAR score (OR: 3.74, 95% CI: 1.29–10.81), low fifth minute APGAR score (OR: 4.17, 95% CI: 1.76–9.91), delayed initiation of breastfeeding (OR: 3.41, 95% CI: 2.18–5.36), and infection of the maternal urinary tract (OR: 3.17, 95% CI: 1.87–5.35).
Duration of rupture of membrane, APGAR score, time of initiation of breastfeeding, and urinary tract infection have a role in the development of neonatal sepsis.
Metabolomics in clinical diagnosis, prognosis, and treatment of infectious diseases
2023, Metabolomics: A Path Towards Personalized Medicine
Infectious diseases are one of the major causes of death worldwide. Therefore clinical management of infectious disease requires robust biomarkers that have diagnostic and prognostic values. While tests for point of care are available for clinical diagnosis, these can be applied to limited number of disease diagnosis. Therefore technologies that can be used to detect host’s response with detailed information on the disease phenotype enable clinicians to decide better treatment and disease management. Metabolites, which are small molecules and end product of the host’s and the pathogens’ metabolic pathways, provide important information and can be used for diagnosis, prognosis, and treatment purpose of infectious diseases. Metabolites as biomarkers are essential for overcoming the limits in the diagnosis, prognosis, and management of infectious diseases. In this chapter, a general workflow of metabolomics has been outlined with advantages over other methods used for diagnosis of infectious diseases. Subsequently, different analytical approaches used for the detection of targeted and untargeted metabolites are discussed. The contribution of metabolic biomarkers for diagnosis, prognosis, drug targets, and monitoring of the efficacy of treatment is highlighted. Following extensive review of literatures in the field, a comprehensive list of metabolic biomarkers of infectious diseases caused by virus, bacteria, fungi, and parasites is presented. In addition, current challenges in the management of infectious diseases in terms of treatment and technological platforms are discussed. Extensive future research in metabolomics of infectious diseases will be a precious clinical resource for overcoming misdiagnosis, understanding disease mechanisms, getting drug targets and treatment strategies with affordable cost, leading to an efficient management of patients.
Virulence factors of uropathogens and their role in host pathogen interactions
2022, The Cell Surface
Gram-positive and Gram-negative bacterial pathogens are commonly found in Urinary Tract Infection (UTI), particularly infected in females like pregnant women, elder people, sexually active, or individuals prone to other risk factors for UTI. In this article, we review the expression of virulence surface proteins and their interaction with host cells for the most frequently isolated uropathogens: Escherichia coli, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus saprophyticus. In addition to the host cell interaction, surface protein regulation was also discussed in this article. The surface protein regulation serves as a key tool in differentiating the pathogen isotypes. Furthermore, it might provide insights on novel diagnostic methods to detect uropathogen that are otherwise easily overlooked due to limited culture-based assays. In essence, this review shall provide an in-depth understanding on secretion of virulence factors of various uropathogens and their role in host-pathogen interaction, this knowledge might be useful in the development of therapeutics against uropathogens.
The Role of Metabolomics and Microbiology in Urinary Tract Infection
2024, International Journal of Molecular Sciences
Positive Bacterial Culture among Adults with Suspected Urinary Tract Infections Presenting to the Department of Medicine of a Tertiary Care Centre
2024, Journal of the Nepal Medical Association

View all citing articles on Scopus

View full text

The etiology of urinary tract infection: traditional and emerging pathogens

Abstract

Section snippets

Uncomplicated urinary tract infections

Overview

Pathogenesis of UTI

Conclusions

Int J Antimicrob Agents

Int J Antimicrob Agents

Infect Dis Clin North Am

Am J Med

Am J Infect Control

Am J Infect Control

Int J Antimicrob Agents

Microbes Infect

J Urol

Int J Antimicrob Agents

Lancet

J Urol

J Urol

J Infect

Management of urinary tract infections in adults

N Engl J Med

Candiduriaa randomized, double-blind study of treatment with fluconazole and placebo

Clin Infect Dis

Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women

JAMA