Recurrent Urinary tract Infection Vaccine (Tetravalent ExPEC4vO-Conjugate)

FDA has recently approved the long awaited vaccine for Escherichia Coli serotypes (ExPEC4V) which is a genuine response to women with recurrent or repetitive urinary tract infection.

This vaccine is the only one that is well tolerated and arrived for urogenital issues, which main causes are due to E coli at a rate of 80-85%.

Extra-intestinal pathogenic Escherichia coli (ExPEC) are major human pathogens and E coli is the most multi-resistant gram negative bacteria to many antibiotics, which most of those bacteria are found in four serotypes (O1A, O2, O61, O25B) and can cause both urogenital and blood stream infection.

When the patient presents at least four episodes of Urinary tract infection was enrolled to the vaccine test in a clinical trial research and has shown a good response of immunogenicity after taking vaccine at day 30 compared to the baseline IgG (Immunoglobulin G).

Biofilm issues

Biofilms are surface attached bacterial species with encasement in a matrix of extracellular DNA, proteins and exopolysaccharides.  They enhance transmission and infectivity of pathogens and provide protection from human defense mechanisms and antibiotics with increased persistence, environmental survival and virulence at 80% (Laura, 2016).

Resistant antibiotics

Recently Gram-negative bacteria with resistance to commonly used antibiotics, including quinolones, colistins (polymyxins), carbapenems, cephalosporins, and other β-lactam antibiotics, have been isolated from humans with increasing frequency. These bacteria use a wide variety of mechanisms to resist antimicrobial killing, many of which are carried on mobile genetic elements transmitted to other bacteria.

Colicitin-Resistant mcr-1 E. coli, this drug belongs in carbapenems class used in last resort, type of resistance was found in USA, Canada and Europe. Researchers request to act quickly as we will be found without any treatment for Multi-resistant gram negative bacteria.

Current Promise antibiotic for Complicated UTI

According the study done by the APEKs-c UTI, in this research they found Cefiderocol (S-649266) to be the best drug in Complicated Urinary tract Infection by gram negative Bacteria.


The attention has to be made about the antibiogram, early treatment, drug compliance and follow up due to the increasing resistance of E coli to antibiotics and long suffering of patients, associated with impaired quality of life of women with repetitive UTI.


  1. Laura M. Sanchez, Andrew T. Cheng , Christopher J. A. Warner, Loni Townsley, Kelly C. Peach, Gabriel Navarro, Nicholas J. Shikuma, Walter M. Bray, Romina M. Riener, Fitnat H. Yildiz, Roger G. Linington, Biofilm Formation and Detachment in Gram-Negative Pathogens Is Modulated by Select Bile Acids, Pone, 2016
  2. Huttner A, Hatz C, van den Dobbelsteen G, et al. Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial (published online February 23, 2017). Lancet Infect Dis. 2017.
  3. Nicolle LE. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am. 2008.
  4. van den Dobbelsteen, Faé , Serroyen , van den Nieuwenhof , Braun , Haeuptle M, Sirena , Schneider , Alaimo, Lipowsky , Gambillara-Fonck, Wacker, Poolman; Immunogenicity and safety of a tetravalent E. coli O-antigen bioconjugate vaccine in animal models, j.vaccine, Epub,2016

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