SUMMARYLatin America has a high rate of community-associated infections caused by
multidrug-resistant Enterobacteriaceae relative to other world regions. A review of the
literature over the last 10 years indicates that urinary tract infections (UTIs) by
Escherichia coli, and intra-abdominal infections (IAIs) by E.
coli and Klebsiella pneumoniae, were characterized by high
rates of resistance to trimethoprim/sulfamethoxazole, quinolones, and second-generation
cephalosporins, and by low levels of resistance to aminoglycosides, nitrofurantoin, and
fosfomycin. In addition, preliminary data indicate an increase in IAIs by
Enterobacteriaceae producing extended-spectrum β-lactamases, with reduced
susceptibilities to third- and fourth-generation cephalosporins. Primary-care physicians
in Latin America should recognize the public health threat associated with UTIs and IAIs
by resistant Gram-negative bacteria. As the number of therapeutic options become limited,
we recommend that antimicrobial prescribing be guided by infection severity, established
patient risk factors for multidrug-resistant infections, acquaintance with local
antimicrobial susceptibility data, and culture collection.