Catheter-associated urinary tract infections: how multidrug-resistant uropathogenic Escherichia coli leads to infection and prevention strategies

Urinary tract infections (UTIs) are among the most prevalent bacterial illnesses worldwide, with uropathogenic Escherichia coli (UPEC) identified as their leading cause. UPEC's pathogenicity arises from a diverse arsenal of virulence factors – including fimbriae, capsular polysaccharides, iron acquisition systems, and toxins – that promote adhesion, invasion, biofilm formation, and immune evasion, often resulting in chronic or recurrent infections. The growing incidence of multidrug-resistant (MDR) UPEC strains, particularly those producing extended-spectrum β-lactamases (ESBLs), compounds therapeutic challenges and elevates risks of treatment failure, especially in catheter-associated UTIs (CAUTIs). Advances in next-generation sequencing (NGS) have revolutionized the simultaneous detection of resistance and virulence determinants, enabling improved surveillance, outbreak tracking, and individualized therapy decisions. The interplay between resistance and virulence – often co-selected on mobile genetic elements – further complicates clinical management. Emerging approaches such as anti-virulence agents, phage therapy, novel drug combinations, and digital surveillance hold promise, but require continued research and vigilant stewardship. Integrating molecular diagnostics with innovative therapeutics is critical to controlling the impact of MDR UPEC and improving patient outcomes in the era of rising antimicrobial resistance.