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Recurrent Urinary Tract Infections (UTIs): A Review and Proposal for Clinicians
Open accessAbstract
The pathogenesis of recurrent urinary tract infections (rUTIs), a common problem in the female population, is becoming better understood following recent studies of bacterial persistence and intracellular bacterial communities. Incorporating these new insights, we propose pulsed antibiotic therapy with intracellular activity as a possible treatment for rUTIs.
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![Figure 2 Diagram of the urinary bladder with intracellular bacterial community (IBC) maturation and development. The left half of the bladder (urine culture: positive) shows phases of IBC development during which bacteria are present in the lumen of the bladder with bacteria susceptible to antibiotics and detected by the host immune system. The right half of the bladder (urine culture: negative) shows phases of IBC development with bacteria protected from antibiotic therapy and undetected by the host immune system (modified from Kim A and others, 2021) [13].](/paper-figures/1da393b32f0d4a1e927d1dcdbdb92d98/recurrent-urinary-tract-infections-utis-a-review-and-proposal-for-clinicians-figure-2.jpg)
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“IBCs are bacteria contained in the endosomes of urothelial cells protected by the antibiotic effect during therapy [22].”
From Vaginal microbiota and urinary tract infections in women: the protective role of vaginal lactobacilli in counteracting urinary tract infections occurrence and recurrence (2026) · cites this paper as [22]
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“The IBCs may lead to a phenomenon known as Bacterial persistence: an identical pathogen remaining dormant between two isolated episodes of UTIs [5, 22].”
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“Recurrent UTIs are often caused by the same bacterium that remains hidden in the bladder between an acute cystitis event and a subsequent infection that is undetected by urine culture collected 2 or 3 weeks after a short term antibiotic treatment [22].”
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“To date, the standard therapy for recurrent UTIs is to treat each episode using a short antibiotic treatment cycle. When the interval between infection events is short, prolonged use of prophylactic antibiotics may be administered [22].”
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Llor, C., & Bjerrum, L. (2014) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098614554919 · Cited by 2,079
Detection of Intracellular Bacterial Communities in Human Urinary Tract Infection
Rosen, D. A., Hooton, T. M., Stamm, W. E., Humphrey, P. A., & Hultgren, S. J. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040329 · Cited by 651
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Metadata
- Authors
- Sgarabotto, D., Andretta, E., & Sgarabotto, C.
- Affiliations
- Policlinico Abano Terme (IT)
- Spinal Unit, Oras Hospital, 31045 Motta di Livenza, Treviso, Italy
- Department of Anesthesia and Intensive Care Unit, ULSS6 Euganea, 35013 Cittadella, Padova, Italy
- Corresponding author
- Sgarabotto, Dino
- Venue
- Antibiotics
- Publisher
- MDPI AG
- Published
- 2025-01-02
- Volume
- 14
- Issue
- 1
- Pages
- 22
- ISSN
- 2079-6382 (ISSN-L)
- PMC
- PMC11762684
- OpenAlex
- W4405992286
- Cited by
- 9
- References
- 2
- Citations by year
- 2026: 8 · 2025: 1
- FWCI
- 6.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Antibiotics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Urology › Urinary Tract Infections Management
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Urology and Nephrology Studies
- Keywords
- recurrent urinary tract infection, pathogenesis, bacterial persistence, intracellular bacterial communities, women
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