Mechanisms and clinical implications of bacterial persistence in recurrent urinary tract infections

Recurrent urinary tract infections (rUTIs) represent a significant clinical challenge, particularly among women and catheterized patients, leading to diminished quality of life and increased healthcare utilization. A central factor in rUTI pathogenesis is bacterial persistence despite seemingly appropriate antibiotic therapy. Unlike classical antibiotic resistance, persistence involves phenotypic adaptations that allow uropathogens to evade both host immune responses and antimicrobial agents. This review examines the multifactorial mechanisms underlying bacterial persistence, including intracellular survival strategies, biofilm formation, antibiotic tolerance, and host immune evasion. An improved understanding of these processes is essential for developing novel, targeted therapeutic strategies that go beyond traditional antimicrobial approaches and address the root causes of recurrence.