An Update on the Management of Urinary Tract Infections in an Era of Drug Resistance: Anti-Biofilm Strategy

Abstract

Urinary Tract Infections (UTI) may be defined as a condition in which bacteria are established and multiplying within the urinary tract.The assessment of suspected UTI includes identification of characteristic symptoms or signs, urinalysis, dipstick or microscopic tests, and urine culture. Microbial species most often associated with specific types of UTI’s includes Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae,Proteus. mirabilis, Citrobacter species and Staph. aureus. In the past few years, notable advances have occurred in our understanding of the epidemiology and clinical importance of drug resistance among uropathogens that cause urinary tract infections (UTIs). Increasing rates of antibiotic or drug resistance necessitate judicious use of antibioticsor drugs through the application of antimicrobial stewardship principles. Knowledge of the common causative pathogens of UTIs including local susceptibility patterns is essential in determining appropriate empiric therapy. Treatment options for UTIs caused by multidrug resistant (MDR)-bacteria includes Variety of drugs includescefoxitin, piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, & aminoglycosides. Based on identification and susceptibility results, alternatives to carbapenems may be used to treat mild-moderate UTIs caused by ESBL-producing bacteria. Treatment options for UTIs caused by multidrug resistant (MDR)-bacteria includes fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, aminoglycosides, colistin, ceftazidime-avibactam, and ceftolozane-tazobactam. Biofilms are a major form of microbial life in which bacteria form dense surface-associated communities, typically enclosed in a matrix of self-produced exopolymeric substances (EPS). Bacteria within biofilms are up to 1,000 times more tolerant to antibiotics, disinfectants, mechanical removal, and other stresses, and this tolerance heavily impedes antimicrobial treatment. Hence, persistent biofilm infections and contaminations widely occur and cause a tremendous amount of problems in medicine. This urges the need for strategies that inhibit biofilm formation and render microbes susceptible to treatment. Several approaches have been proposed ranging from blocking bacterial attachment, to inhibiting or destabilizing EPS, and interfering with quorum sensing. Given the limited permeability of established biofilms, particular promise comes from strategies that continually treat surfaces to prevent the formation of biofilms.Alternative treatment method based on controlling production of Extracellular polymeric substances (EPS) which are responsible for Biofilms development and it is an extremely tolerant to antimicrobials. As for antibiotics the problem with any long-term treatment strategies is the potential for resistance evolution. We need anti-biofilm strategies, therefore, that also limit the evolution of resistance. One option is to use combinations of therapies, which use multiple drugs to limit resistance. More desirable still would be the discovery of single strategies where resistance evolution never occurs, so called evolution proof strategies. Inhibiting EPS, therefore, offers a route to inhibit biofilms, and reduce major problems. Moreover, EPS has the potential to be shared with other cells, rendering it a potential public good, meaning that its inhibition may be subject to the hypothesized counter-selection of resistance.

Keywords: Urinary tract infection, uropathogens, Drug resistance, Exopolymeric Substances EPS