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Antibiotics
Special Issues
From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics
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From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics

A Special Issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 July 2026) | Viewed by 26481

Editor

Dr. Eleonora Nicolai

E-Mail Website
Guest Editor
Departmental Faculty of Medicine, UniCamillus- Saint Camillus International University of Health and Medical Sciences, Via di S.Alessandro 8, 00132, Rome, Italy
Interests: fluorescence; rapid AST (antibiotic susceptibility testing); microbiology diagnostic; FCS (fluorescence correlation spectroscopy); biophysics; fast bacteriuria screening
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Urinary tract infections (UTIs) are a common and uncomfortable condition that affects millions of people worldwide. UTIs can range from mild discomfort to severe complications if left untreated. Antibiotics play a crucial role in the detection and treatment of UTIs, providing relief and preventing further complications.

A urinary tract infection occurs when bacteria enter the urinary system and multiply, leading to infection. Common symptoms include a strong, persistent urge to urinate, a burning sensation during urination, cloudy or bloody urine, and pelvic pain. It is essential to recognize these signs and seek medical attention promptly to prevent the infection from spreading to the kidneys or other parts of the body.

To diagnose a UTI, healthcare providers typically perform a physical examination and request a urine sample for analysis. This analysis involves a urine culture and sensitivity test, which identifies the type of bacteria causing the infection and determines the most effective antibiotic treatment. Prompt and accurate detection is crucial in initiating timely treatment and preventing complications.

The selection of an appropriate antibiotic for UTI treatment is based on several factors, including the type of bacteria identified, its susceptibility to different antibiotics, the patient's medical history, and any potential allergies. UTI treatment with antibiotics typically lasts from three to seven days, depending on the severity of the infection and the prescribed medication. It is crucial to complete the entire course of antibiotics, even if symptoms improve before completion. Skipping doses or stopping medication prematurely can lead to antibiotic resistance and recurrent infections.

While antibiotics are highly effective in treating UTIs, they can have side effects. In rare cases, individuals may develop antibiotic-resistant strains of bacteria. Responsible antibiotic use is essential to minimize the risk of antibiotic resistance.

Improving knowledge surrounding detection and treatment will help to increase patient well-being.

The present Special Issue is focused both on problems and new solutions related to diagnostics, exploring both clinical and pharmaceutical approaches related to UTI treatment.

Dr. Eleonora Nicolai
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (6 papers)

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Research

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19 pages, 1002 KB  
Article
Does a Loading Dose Improve Outcomes? Colistin Therapy for Urinary Tract Infections Caused by Multidrug-Resistant Gram-Negative Bacteria
by Wasan Katip, Puntapong Taruangsri, Siriporn Okonogi, Shaun Wen Huey Lee and Ajaree Rayanakorn
Antibiotics 2026, 15(8), 812; https://doi.org/10.3390/antibiotics15080812 - 19 Aug 2026
Viewed by 207
Abstract
Background: Colistin remains an important therapeutic option for complicated urinary tract infections (cUTIs) caused by multidrug-resistant Gram-negative bacteria. A loading dose is often recommended to rapidly achieve steady-state plasma concentrations, but its clinical benefit specifically for cUTIs, where local urinary drug concentrations markedly [...] Read more.
Background: Colistin remains an important therapeutic option for complicated urinary tract infections (cUTIs) caused by multidrug-resistant Gram-negative bacteria. A loading dose is often recommended to rapidly achieve steady-state plasma concentrations, but its clinical benefit specifically for cUTIs, where local urinary drug concentrations markedly exceed plasma levels, remains unclear. Methods: We conducted a retrospective cohort study of adult patients treated with intravenous colistin for cUTIs at Nakornping Hospital, Chiang Mai, Thailand, between 2015 and 2022. Patients were classified as receiving loading-dose (LD) or non-loading-dose (non-LD) colistin. The primary outcome was 30-day all-cause mortality. Secondary outcomes included clinical response, microbiological response, and nephrotoxicity (defined by RIFLE criteria). Inverse probability weighting (IPW) using the propensity score was applied to adjust for baseline covariates, and Cox proportional hazards regression was used to estimate crude and adjusted hazard ratios (HR) using the non-LD group as the reference. Results: Among 123 patients (74 LD, 49 non-LD), unadjusted 30-day all-cause mortality was 35.14% versus 40.82% (p = 0.524), clinical response was 75.68% versus 71.43% (p = 0.599), and microbiological response was 78.38% versus 65.31% (p = 0.109) for LD versus non-LD, respectively. Nephrotoxicity occurred in 48.65% versus 38.78% (p = 0.281). After IPW adjustment, no statistically significant differences were observed between the LD and non-LD groups for 30-day all-cause mortality (aHR 0.78, 95% CI 0.43–1.42, p = 0.419), clinical response (aOR 1.48, 95% CI 0.54–4.08, p = 0.445), or microbiological response (aOR 2.10, 95% CI 0.81–5.48, p = 0.128). For the safety outcome, nephrotoxicity was analyzed using the Fine–Gray competing risk model, treating death as a competing event. The IPW-adjusted subdistribution hazard ratio was (asHR) 2.23 (95% CI 0.83–5.95, p = 0.110), indicating no statistically significant difference in renal safety between the LD and non-LD groups. Conclusions: Loading-dose colistin was not associated with a statistically significant reduction in 30-day all-cause mortality or improvements in clinical response and microbiological eradication in patients with cUTIs. Nephrotoxicity was numerically lower without a loading dose, but the wide confidence intervals in this study of 123 patients precluded a definitive conclusion regarding renal safety. Omitting the loading dose may be a reasonable option for localized urinary infections, particularly in patients at high risk for acute kidney injury, pending confirmation in larger prospective studies. Full article
(This article belongs to the Special Issue From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics)
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11 pages, 551 KB  
Article
Artificial Neural Network for the Fast Screening of Samples from Suspected Urinary Tract Infections
by Cristiano Ialongo, Marco Ciotti, Alfredo Giovannelli, Flaminia Tomassetti, Martina Pelagalli, Stefano Di Carlo, Sergio Bernardini, Massimo Pieri and Eleonora Nicolai
Antibiotics 2025, 14(8), 768; https://doi.org/10.3390/antibiotics14080768 - 30 Jul 2025
Cited by 2 | Viewed by 1358
Abstract
Background: Urine microbial analysis is a frequently requested test that is often associated with contamination during specimen collection or storage, which leads to false-positive diagnoses and delayed reporting. In the era of digitalization, machine learning (ML) can serve as a valuable tool to [...] Read more.
Background: Urine microbial analysis is a frequently requested test that is often associated with contamination during specimen collection or storage, which leads to false-positive diagnoses and delayed reporting. In the era of digitalization, machine learning (ML) can serve as a valuable tool to support clinical decision-making. Methods: This study investigates the application of a simple artificial neural network (ANN) to pre-identify negative and contaminated (false-positive) specimens. An ML model was developed using 8181 urine samples, including cytology, dipstick tests, and culture results. The dataset was randomly split 2:1 for training and testing a multilayer perceptron (MLP). Input variables with a normalized importance below 0.2 were excluded. Results: The final model used only microbial and either urine color or urobilinogen pigment analysis as inputs; other physical, chemical, and cellular parameters were omitted. The frequency of positive and negative specimens for bacteria was 6.9% and 89.6%, respectively. Contaminated specimens represented 3.5% of cases and were predominantly misclassified as negative by the MLP. Thus, the negative predictive value (NPV) was 96.5% and the positive predictive value (PPV) was 87.2%, leading to 0.82% of the cultures being unnecessary microbial cultures (UMC). Conclusions: These results suggest that the MLP is reliable for screening out negative specimens but less effective at identifying positive ones. In conclusion, ANN models can effectively support the screening of negative urine samples, detect clinically significant bacteriuria, and potentially reduce unnecessary cultures. Incorporating morphological information data could further improve the accuracy of our model and minimize false negatives. Full article
(This article belongs to the Special Issue From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics)
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17 pages, 5646 KB  
Article
The Impact of Urinary Catheterization on the Antibiotic Susceptibility of ESBL-Producing Enterobacterales: A Challenging Duo
by Ionela-Larisa Miftode, Andrei Vâță, Radu-Ștefan Miftode, Tudorița Parângă, Mihaela Cătălina Luca, Carmen Manciuc, Amalia Stefana Țimpău, Viorel Radu, Manuel Florin Roșu, Lidia Oana Stămăteanu, Daniela Leca, Dana Teodora Anton-Păduraru and Egidia Gabriela Miftode
Antibiotics 2024, 13(5), 462; https://doi.org/10.3390/antibiotics13050462 - 17 May 2024
Cited by 8 | Viewed by 5147
Abstract
Introduction: Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations [...] Read more.
Introduction: Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations tailored to local susceptibility patterns. Results: We found a high prevalence of ESBL-producing strains (36.9%), with Escherichia coli and Klebsiella spp. being the most prevalent isolated bacteria. Among the catheterized patients, Klebsiella spp. emerged as the primary etiology, with a significant correlation between catheterization and Proteus spp. (p = 0.02) and Providencia stuartii (p < 0.0001). We observed significant correlations between urinary catheterization and older age (68.9 ± 13.7 years vs. 64.2 ± 18.1 years in non-catheterized patients, p = 0.026) and with the presence of an isolate with extensive drug resistance (p < 0.0001) or even pandrug resistance (p < 0.0001). Susceptibility rates significantly decreased for almost all the tested antibiotics during the study period. Notably, susceptibility was markedly lower among catheterized patients, with the most pronounced differences observed for carbapenems (59.6% versus 83.4%, p < 0.0001) and aminoglycosides (37.1% versus 46.9%, p = 0.0001). Materials and Methods: We conducted a retrospective study analyzing the susceptibility profiles of 724 extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales isolated from urine cultures. Our focus was on highlighting susceptibility profiles among isolates associated with urinary catheterization and assessing the shifts in the susceptibility rates over time. Conclusions: The constant rise in AMR rates among Enterobacterales presents significant challenges in treating severe infections, particularly among urinary catheterized patients. This trend leaves clinicians with limited or no effective treatment options. Consequently, the development and implementation of personalized treatment protocols are imperative to ensure efficient empirical therapies. Full article
(This article belongs to the Special Issue From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics)
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14 pages, 1454 KB  
Article
Acidic Urine pH and Clinical Outcome of Lower Urinary Tract Infection in Kidney Transplant Recipients Treated with Ciprofloxacin and Fosfomycin
by Soraya Herrera-Espejo, Sara Fontserè, Carmen Infante, Alejandro Suárez-Benjumea, Marta Carretero-Ledesma, Marta Suñer-Poblet, Carmen González-Corvillo, Gabriel Bernal, Guillermo Martín-Gutiérrez, Juan Antonio Pérez-Cáceres, Jerónimo Pachón, María Eugenia Pachón-Ibáñez and Elisa Cordero
Antibiotics 2024, 13(2), 116; https://doi.org/10.3390/antibiotics13020116 - 24 Jan 2024
Cited by 8 | Viewed by 6404
Abstract
Different factors, including antimicrobial resistance, may diminish the effectiveness of antibiotic therapy, challenging the management of post-transplant urinary tract infection (UTI). The association of acidic urine pH with microbiological and clinical outcomes was evaluated after fosfomycin or ciprofloxacin therapy in 184 kidney transplant [...] Read more.
Different factors, including antimicrobial resistance, may diminish the effectiveness of antibiotic therapy, challenging the management of post-transplant urinary tract infection (UTI). The association of acidic urine pH with microbiological and clinical outcomes was evaluated after fosfomycin or ciprofloxacin therapy in 184 kidney transplant recipients (KTRs) with UTI episodes by Escherichia coli (N = 115) and Klebsiella pneumoniae (N = 69). Initial urine pH, antimicrobial therapy, and clinical and microbiological outcomes, and one- and six-month follow-up were assessed. Fosfomycin was prescribed in 88 (76.5%) E. coli and 46 (66.7%) K. pneumoniae UTI episodes in the total cohort. When the urine pH ≤ 6, fosfomycin was prescribed in 60 (52.2%) E. coli and 29 (42.0%) K. pneumoniae. Initial urine pH ≤ 6 in E. coli UTI was associated with symptomatic episodes (8/60 vs. 0/55, p = 0.04) at one-month follow-up, with a similar trend in those patients receiving fosfomycin (7/47 vs. 0/41, p = 0.09). Acidic urine pH was not associated with microbiological or clinical cure in K. pneumoniae UTI. At pH 5, the ciprofloxacin MIC90 increased from 8 to >8 mg/L in E. coli and from 4 to >8 mg/L in K. pneumoniae. At pH 5, the fosfomycin MIC90 decreased from 8 to 4 mg/L in E. coli and from 512 to 128 mg/L in K. pneumoniae. Acidic urine is not associated with the microbiological efficacy of fosfomycin and ciprofloxacin in KTRs with UTI, but it is associated with symptomatic UTI episodes at one-month follow-up in E. coli episodes. Full article
(This article belongs to the Special Issue From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics)
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Review

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22 pages, 334 KB  
Review
Treatment of Urinary Tract Infections in Neonates and Young Infants: Evidence and Recommendations
by Manar O. Lashkar and Milap C. Nahata
Antibiotics 2026, 15(8), 788; https://doi.org/10.3390/antibiotics15080788 - 14 Aug 2026
Viewed by 205
Abstract
Background/Objectives: Urinary tract infection (UTI) is among the most common serious bacterial infections occurring in the first 90 days of life and a leading indication for parenteral antibiotic therapy. Despite its clinical importance, no randomized trial has compared empiric antibiotic regimens, route of [...] Read more.
Background/Objectives: Urinary tract infection (UTI) is among the most common serious bacterial infections occurring in the first 90 days of life and a leading indication for parenteral antibiotic therapy. Despite its clinical importance, no randomized trial has compared empiric antibiotic regimens, route of administration, or treatment duration specifically in this population. This review synthesizes current evidence to support rational antibiotic treatment decisions for neonates (ages 0–28 days) and young infants (ages 29–90 days), including those born prematurely. Methods: A targeted PubMed and MEDLINE search was conducted through July 2026. Studies reporting treatment outcomes, pharmacokinetic data, or antibiotic safety in infants aged 0–90 days were included. Broader pediatric data were incorporated where age-specific evidence was unavailable and are presented with explicit population caveats. Results:Escherichia coli is the predominant uropathogen across all age strata; extended-spectrum beta-lactamase (ESBL)-producing organisms account for a clinically important minority of community-acquired isolates. No comparative trial of empiric regimens existed for confirmed UTI in this age group. Shorter intravenous courses were not associated with higher 30-day recurrence rates for either nonbacteremic or bacteremic UTI after exclusion of meningitis. Intravenous-to-oral (IV-to-oral) transition with amoxicillin–clavulanate was pharmacokinetically supported and clinically safe in selected term neonates, based on indirect evidence from neonatal infection trials. Non-carbapenem therapy is appropriate for ESBL UTI without concomitant bacteremia in clinically improving infants. Exclusion of meningitis before shortening intravenous therapy or initiating oral step-down is essential, particularly in neonates ≤ 28 days of age. Conclusions: Short parenteral courses with timely transition to oral antibiotics are recommended in appropriately selected infants with UTI, consistent with antimicrobial stewardship principles and supported by observational evidence. The evidence base is limited, with key gaps in empiric regimen selection, management of premature infants, ESBL treatment in bacteremic patients, and optimal duration of parenteral and oral antibiotic therapy. Full article
(This article belongs to the Special Issue From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics)
17 pages, 1445 KB  
Review
Novel Antimicrobial Approaches to Combat Bacterial Biofilms Associated with Urinary Tract Infections
by Giuseppe Mancuso, Marilena Trinchera, Angelina Midiri, Sebastiana Zummo, Giulia Vitale and Carmelo Biondo
Antibiotics 2024, 13(2), 154; https://doi.org/10.3390/antibiotics13020154 - 4 Feb 2024
Cited by 39 | Viewed by 11613
Abstract
Urinary tract infections (UTIs) are prevalent bacterial infections in both community and healthcare settings. They account for approximately 40% of all bacterial infections and require around 15% of all antibiotic prescriptions. Although antibiotics have traditionally been used to treat UTIs for several decades, [...] Read more.
Urinary tract infections (UTIs) are prevalent bacterial infections in both community and healthcare settings. They account for approximately 40% of all bacterial infections and require around 15% of all antibiotic prescriptions. Although antibiotics have traditionally been used to treat UTIs for several decades, the significant increase in antibiotic resistance in recent years has made many previously effective treatments ineffective. Biofilm on medical equipment in healthcare settings creates a reservoir of pathogens that can easily be transmitted to patients. Urinary catheter infections are frequently observed in hospitals and are caused by microbes that form a biofilm after a catheter is inserted into the bladder. Managing infections caused by biofilms is challenging due to the emergence of antibiotic resistance. Biofilms enable pathogens to evade the host’s innate immune defences, resulting in long-term persistence. The incidence of sepsis caused by UTIs that have spread to the bloodstream is increasing, and drug-resistant infections may be even more prevalent. While the availability of upcoming tests to identify the bacterial cause of infection and its resistance spectrum is critical, it alone will not solve the problem; innovative treatment approaches are also needed. This review analyses the main characteristics of biofilm formation and drug resistance in recurrent uropathogen-induced UTIs. The importance of innovative and alternative therapies for combatting biofilm-caused UTI is emphasised. Full article
(This article belongs to the Special Issue From Detection to Treatment: Navigating Urinary Tract Infections with Antibiotics)
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