Complicated Urinary Tract Infections in the Era of Antimicrobial Resistance: Pathogenesis, Diagnostics, and Therapeutic Innovation

Complicated urinary tract infections represent a major challenge across clinical microbiology, infectious disease, and urology, particularly as antimicrobial resistance increasingly limits empirical and targeted treatment options. Resistant uropathogens, recurrent infection, urinary tract abnormalities, catheterisation, and comorbid conditions contribute to treatment failure and poorer clinical outcomes. Current research has improved understanding of molecular resistance mechanisms, bacterial adaptation, biofilm formation, and host–pathogen interactions, while advances in rapid diagnostics and genomic surveillance may support more precise antimicrobial selection. Nevertheless, important gaps remain in translating these advances into routine clinical practice. Ongoing debates concern the definition and stratification of complicated UTIs, the optimal duration and route of therapy, the role of combination treatment, and how diagnostic stewardship can reduce unnecessary antimicrobial exposure. Further interdisciplinary investigation is needed to connect mechanistic insights with clinically meaningful strategies for prevention, diagnosis, and treatment.This Research Topic aims to examine the biological, diagnostic, therapeutic, and clinical dimensions of complicated UTIs associated with antimicrobial resistance. It will promote research that clarifies how resistance emerges and spreads, identifies host and pathogen factors associated with treatment failure, and evaluates approaches that improve diagnostic accuracy and antimicrobial decision-making. The Research Topic will also assess innovative anti-infective strategies, including bacteriophage-based interventions and other non-traditional therapies, alongside established and emerging antimicrobial treatments. By bringing together clinical microbiology, infectious disease, and urology perspectives, it seeks to support more cohesive and evidence-based approaches to managing patients with resistant uropathogens.To gather further insights into complicated UTIs caused by or associated with antimicrobial-resistant pathogens, this Research Topic will focus on studies spanning laboratory, translational, and clinical research, while excluding urinary infections that are uncomplicated and readily managed without consideration of resistance, structural abnormalities, or relevant host factors. We welcome original research, reviews, perspectives, and related article types addressing, but not limited to, the following themes:- Molecular mechanisms and genetic determinants of antimicrobial resistance in uropathogens- Genomic epidemiology, transmission, and surveillance of resistant urinary pathogens- Host–pathogen interactions, virulence, immune responses, and bacterial persistence- Biofilms, catheter-associated infections, recurrent UTIs, and urinary tract abnormalities- Rapid diagnostics, antimicrobial susceptibility testing, biomarkers, and point-of-care technologies- Diagnostic stewardship and optimisation of empirical and targeted antimicrobial therapy- Novel antibiotics, combination therapies, and antimicrobial-sparing treatment strategies- Bacteriophage therapy, phage-derived products, and other non-traditional anti-infective approaches- Prevention of antimicrobial resistance and infection-control interventions- Clinical outcomes, treatment failure, recurrence, mortality, and patient-reported outcomes- Interdisciplinary models integrating clinical microbiology, infectious disease, and urology- Translational studies connecting experimental findings with clinical implementation Topic editors: Javier Garau, Ivan Mikhailovich Pchelin Source: https://www.frontiersin.org/research-topics/86115/complicated-urinary-tract-infections-in-the-era-of-antimicrobial-resistance-pathogenesis-diagnostics-and-therapeutic-innovation