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Bacterial adhesion strategies and countermeasures in urinary tract infection

Nature Microbiology volume 10, pages 627–645 (2025)Cite this article

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Abstract

Urinary tract infections (UTIs) are compounded by antimicrobial resistance, which increases the risk of UTI recurrence and antibiotic treatment failure. This also intensifies the burden of disease upon healthcare systems worldwide, and of morbidity and mortality. Uropathogen adhesion is a critical step in the pathogenic process, as has been mainly shown for Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus agalactiae, Proteus, Enterococcus and Staphylococcus species. Although many bacterial adhesion molecules from these uropathogens have been described, our understanding of their contributions to UTIs is limited. Here we explore knowledge gaps in the UTI field, as we discuss the broader repertoire of uropathogen adhesins, including their role beyond initial attachment and the counter-responses of the host immune system. Finally, we describe the development of therapeutic approaches that target uropathogenic adhesion strategies and provide potential alternatives to antibiotics.

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Fig. 1: Uropathogen adhesion during UTI progression.
Fig. 2: Gram-negative and Gram-positive uropathogen adhesion factors and cognate targets in the urinary tract.
Fig. 3: Uropathogen adhesin functions beyond attachment during UTI.
Fig. 4: Host cell responses to counter uropathogen adhesion.
Fig. 5: Therapeutic strategies targeting uropathogen adhesion.

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Acknowledgements

C.F. is funded by the International Human Frontier Science Program Organization (HFSPO, ref. LT0017/2023-L).

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  1. Biozentrum, University of Basel, Basel, Switzerland

    Carlos Flores

  2. Centre for Urological Biology, Division of Medicine, University College London, London, UK

    Jennifer L. Rohn

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C.F. and J.L.R. conceptualized and wrote this Review. C.F. prepared the figures and tables.

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Flores, C., Rohn, J.L. Bacterial adhesion strategies and countermeasures in urinary tract infection. Nat Microbiol 10, 627–645 (2025). https://doi.org/10.1038/s41564-025-01926-8

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