Treatment of Urinary Tract Infection in Pregnancy Caused by Enterococcus faecalis: An Alternative Management

Abstract

Background: Urinary tract infections (UTIs) during pregnancy are a significant public health concern due to their potential risk to maternal and child health. Among other prevalent organisms, Enterococcus faecalis has emerged as a key pathogen, with virulence genes, biofilm-forming ability, and multidrug resistance as significant pathogenic properties. Objective: This review examines the pathogenic mechanisms, diagnostic innovations, treatment challenges, and alternative therapeutic strategies for E. faecalis-induced UTIs during pregnancy. Methods: A literature review was conducted to examine virulence factors, diagnostic advancements, conventional antibiotic therapies, and emerging alternatives. Results: E. faecalis exhibits multiple virulence traits, including adhesion proteins (Agg, Ace), gelatinase, hemolysin, and surface proteins (Esp), which facilitate colonisation, immune evasion, and biofilm formation. Diagnostic innovations such as molecular assays, metabolomics-based biomarkers, microfluidic platforms, and AI-assisted urinalysis have improved the accuracy of rapid detection. While nitrofurantoin has remained a reliable antimicrobial agent, because of its low resistance profile, emerging antimicrobial resistance necessitates the exploration of alternative approaches. These include phage therapy, antimicrobial peptides, immunotherapy, probiotics, and herbal adjuncts. Effective campaigns towards antibiotic stewardship and combination therapy are also critical in managing recurrent and resistant infections. Conclusion: Effective management of urinary tract infections caused by E. faecalis during pregnancy requires a multidisciplinary approach that incorporates advanced technologies, targeted therapeutics, and preventive strategies to improve outcomes and combat antimicrobial resistance.