An update on Escalating Drug Resistance among Uropathogenic Bacteria: Challenges in Treatment and Scope for Maneuver

Uropathogens are among the most common infectious agents in humans worldwide. The problem is further exacerbated by the escalating emergence and dissemination of antibiotic resistance genes (ARGs) among bacteria causing urinary tract infections (UTIs). The World Health Organization (WHO) has identified antibiotic resistance as the most serious public health threat of this century, demanding global action. The most common bacteria contributing approximately 85% of UTIs include Escherichia coli, Klebsiella pneumoniae, and Enterococcus spp. Reports of intrinsic and/ or acquired resistance mechanisms contributing to the emergence and dissemination of multidrug-resistant (MDR) bacteria are on the rise. This review updates the escalating drug resistance among uropathogenic bacteria, scrutinizing the resistance genes, resistance mechanisms, and associated virulence factors such as fimbriae, α-hemolysin (HlyA), Esp, Ebp, Hyaluronidase, etc., which contribute to their persistence and proliferation in healthcare and communal settings. Furthermore, we have discussed the challenges in treatment due to resistance, scope for maneuver, and strategies to counter this menace, including the alternate approaches, viz., vaccines targeting virulence factors, small molecules targeting toxins, plasmid curing compounds, and antiplasmid systems.