The Role of Intracellular Bacterial Communities of Uropathogenic Escherichia Coli in Chronic Urinary Tract Infection and New Therapeutic Ideas

Escherichia coli is the primary pathogen responsible for urinary tract infections (UTI), accounting for approximately 75% of uncomplicated and more than 50% of complicated cases. Its ability to invade intracellularly and form IBCs allows the bacteria to multiply while evading antibiotics and the host’s immune system. E. coli has developed virulence factors that facilitate intracellular invasion, while the plasticity of its genome enables ongoing evolution and adaptation to diverse environments. At present, no available therapy fully eradicates IBCs, highlighting the urgent need for innovative treatment strategies. All methods discussed in this paper address recurrent UTIs and the eradication of IBCs. Among the most promising strategies are the development of new antibiotics, the use of adjunctive agents that enhance intracellular penetration, inhibitors of bacterial adhesion to epithelial cells, and engineered bacteriophages.