Antivirulence strategies targeting adhesion and biofilm formation in uropathogenic E. coli: Recent advances and clinical perspectives-review

Urinary tract infections (UTIs) caused by uropathogenic Escherichia coli (UPEC) represent one of the most prevalent and persistent bacterial diseases globally, with high recurrence and a growing burden of multidrug resistance. Central to UPEC pathogenesis are robust adhesion to uroepithelial surfaces and biofilm formation, mediated by diverse fimbrial and afimbrial adhesins. This review integrates the molecular mechanisms driving UPEC adhesion and biofilm development and provides a focused evaluation of antivirulence strategies that disrupt these processes. Approaches highlighted include small-molecule FimH antagonists, pilicides and curlicides, vaccines targeting adhesins, natural phytocompounds, probiotic interventions, biosurfactants, and innovative biomaterial-based tactics such as antiadhesive catheter coatings. Evidence from in vitro, in vivo, preclinical, and early clinical studies are discussed for each therapeutic class, alongside advances in targeted drug delivery and combination regimens. The review concludes with future perspectives on optimizing safety, overcoming resistance, and integrating antivirulence therapies into standardized clinical practice to break the cycle of UTI persistence.