The role of uropathogenic Escherichia coli biofilms in antibiotic-resistant urinary tract infections: Nanoparticle-based, phage therapy, and quorum-sensing inhibitor approaches.

Abstract

Background: Urinary tract infections (UTIs) caused by uropathogenic E. coli (UPEC) pose a global health challenge, largely due to UPEC biofilms that drive persistent infections and antibiotic resistance.

Materials and methods: To explore the role of UPEC biofilms in antibiotic-resistant UTIs and summarize emerging therapeutic strategies, this study conducted a systematic review adhering to PRISMA guidelines and registered in PROSPERO (CRD420251040212). A structured search of PubMed, Google Scholar, Scopus, and Web of Science identified English-language studies published up to 2024, with 57 eligible studies selected after three-stage screening and analyzed via thematic synthesis.

Results: This study explored UPEC biofilms enhance resistance through extracellular matrix barriers, persister cell formation, efflux pump upregulation, and horizontal gene transfer; emerging therapies including bacteriophage therapy, quorum-sensing inhibitors, and nanoparticle-based drug delivery effectively target biofilms by penetration, signaling disruption, and improved drug efficacy. Additional approaches such as antibiofilm peptides, probiotics, and immunotherapy also demonstrate potential.

Conclusions: The UPEC biofilms are key to chronic UTIs, and novel targeted therapies offer promising solutions, but clinical validation, regulatory hurdles, and combination therapy optimization are critical for translation to clinical practice.