This issue of Urogenital Tract Infection presents a comprehensive and multifaceted examination of the complex resistance mechanisms involved in urinary tract infections (UTIs), incorporating recent updates and clinical insights from leading researchers worldwide. This issue of Urogenital Tract Infection comprises 2 review articles, 2 original investigations, 1 case report, and a letter, and reflects our ongoing commitment to addressing the evolving clinical challenges associated with genitourinary inflammation through rigorous, evidence-based research.

Dong Sup Lee of The Catholic University of Korea provides a comprehensive review of the association between UTIs and urinary stone disease, a topic of increasing relevance in contemporary urological practice. Although infection-related stones have traditionally been attributed to urease-producing bacterial pathogens, recent evidence summarized in this review suggests that the influence of microorganisms—particularly Escherichia coli—on stone formation extends beyond classical infectious calculi. Lee highlights that these pathogens may contribute to the initiation and progression of calcium-based stones through the formation of complex biofilms, and provides a detailed synthesis of the biochemical and pathophysiologic mechanisms linking UTIs with metabolic stone disease. A more comprehensive understanding of these interactions is essential, as it may inform preventive strategies, support more precise antimicrobial and surgical decision-making, and ultimately reduce the high recurrence rates associated with these conditions. In the domain of clinical policy and antimicrobial stewardship, Hee Jo Yang of Soonchunhyang University underscores the urgent need for Korea-specific guidelines for the management of UTIs. Despite the availability of international recommendations, Korea’s distinct epidemiological context—characterized by high rates of fluoroquinolone resistance and extended-spectrum beta-lactamase production, as well as frequent patient transfers between long-term care facilities and tertiary hospitals—necessitates a localized approach. Although national surveillance systems, including Korean Antimicrobial Resistance Monitoring System (KARMS) and KorGLASS (Global Antimicrobial Resistance Surveillance System in Korea), provide valuable longitudinal data, Yang emphasizes that additional evidence is required to develop robust, context-specific guidelines that improve patient safety and optimize antibiotic stewardship in response to the increasing threat of antimicrobial resistance.

This emphasis on antimicrobial resistance is further reinforced by findings reported by Seung Il Jung of Chonnam National University Hwasun Hospital, who analyzed antibiotic resistance patterns among 698 patients with complicated UTIs registered in the KARMS system. This large-scale study identified an extended-spectrum beta-lactamase positivity rate of 45.2%, increasing to more than 62% among patients with pyelonephritis and urosepsis, along with substantial rates of fluoroquinolone resistance, particularly among female patients and those with healthcare-associated infections. These findings underscore the need for continuous surveillance and the development of evidence-based strategies to limit the spread of resistant pathogens. In addition, this issue features a proteomic study by Su Kang Kim of Catholic Kwandong University, selected as the UTI Editors’ Pick. Using Olink Explore proteomic data from the UK Biobank and analyzed via COMPASS, the study identified distinct systemic protein signatures—including CHGA, GAST, CDH2, and GDF15—that differentiate acute from chronic cystitis. This population-level analysis provides a novel framework for characterizing systemic inflammatory profiles and identifying potential plasma biomarkers.

Finally, this issue includes a rare and severe case of bilateral xanthogranulomatous pyelonephritis resulting from untreated chronic neurogenic bladder, presented by Sin Woo Lee of Seoul Medical Center. In addition, Jae Yoon Kim of Inje University provides a commentary on prognostic factors in Fournier’s gangrene, emphasizing the importance of early risk stratification using readily available physiological indicators. Collectively, these contributions offer a contemporary overview of the field, and the insights presented in this issue are expected to inform and support clinicians and researchers engaged in the study of genitourinary infections and inflammation worldwide.

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