The Role of Immune Response in Bacterial Urinary Tract Infections in Iraq: A Review

Abstract

Urinary tract infections (UTIs) are among the most prevalent bacterial infections, frequently caused by uropathogenic Escherichia coli (UPEC), the primary causative agent in humans. The immune system plays a critical role in defending against bacterial UTIs by preventing pathogen attachment and colonization in the urinary epithelium, while also mitigating infection severity through innate and adaptive immune responses. This review examines previous studies conducted in Iraq on the immunological aspects of bacterial UTIs. It explores the mechanisms of antibiotic resistance in UTI-causing bacteria and synthesizes findings from 42 studies that investigate the role of innate and adaptive immunity in UTI-related inflammation. Iraqi research has consistently demonstrated a high prevalence of multidrug-resistant (MDR) UPEC strains, underscoring the urgent need for immune-based interventions, such as vaccines and immunomodulatory therapies, to enhance host defenses and reduce dependence on antibiotics. Key findings highlight the involvement of neutrophils, cytokines, and antimicrobial peptides in immune defense against UPEC, while bacterial immune evasion strategies contribute to recurrent infections. This review also emphasizes the necessity for personalized medicine approaches that integrate genetic and immunological insights to improve UTI prediction, prevention, and treatment in the Iraqi population. Numerous Iraqi studies have reinforced the crucial role of innate immunity in determining UTI susceptibility. A deeper understanding of immune mechanisms in UTI pathogenesis is essential for developing more effective treatment strategies and alleviating the burden of recurrent infections.