Preventing urinary tract infection: progress toward an effective Escherichia coli vaccine

Abstract

Uncomplicated urinary tract infections (UTIs) are common, with nearly half of all women experiencing at least one UTI in their lifetime. This high frequency of infection results in huge annual economic costs, decreased workforce productivity and high patient morbidity. At least 80% of these infections are caused by uropathogenic Escherichia coli (UPEC). UPEC can reside side by side with commensal strains in the gastrointestinal tract and gain access to the bladder via colonization of the urethra. Antibiotics represent the current standard treatment for UTI; however, even after treatment, patients frequently suffer from recurrent infection with the same or different strains. In addition, successful long-term treatment has been complicated by a rise in both the number of antibiotic-resistant strains and the prevalence of antibiotic-resistance mechanisms. As a result, preventative approaches to UTI, such as vaccination, have been sought. This review summarizes recent advances in UPEC vaccine development and outlines future directions for the field.

Figures

Figure 1. Urinary tract infection among women is extremely common; approximately 13% of women between the ages of 18 and 90 years will have an annual incidence of urinary tract infection

Based on 2010 US census data, an estimated 15 million women will have a UTI annually in the USA [118]. Percentages are proportional to the area of the circles. UTI: Urinary tract infection.

Figure 2. Classes of uropathogenic Escherichia coli vaccine targets include fimbrial adhesins, surface polysaccharides, outer membrane iron receptors and toxins

LPS: Lipopolysaccharide; UPEC: Uropathogenic Escherichia coli.