Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens: Table 1.

Abstract

Urinary tract infections (UTIs) are among the most commonly treated bacterial infections. Over the past decade, antimicrobial resistance has become an increasingly common factor in the management of outpatient UTIs. As treatment options for multidrugresistant (MDR) uropathogens are limited, clinicians need to be aware of specific clinical and epidemiological risk factors for these infections. Based on available literature, the activity of fosfomycin and nitrofurantoin remain high for most cases of MDR Escherichia coli UTIs. Trimethoprim-sulfamethoxazole retains clinical efficacy, but resistance rates are increasing internationally. Beta-lactam agents have the highest rates of resistance and lowest rates of clinical success. Fluoroquinolones have high resistance rates among MDR uropathogens and are being strongly discouraged as first-line agents for UTIs. In addition to accounting for local resistance rates, consideration of patient risk factors for resistance and pharmacological principles will help guide optimal empiric treatment of outpatient UTIs.

Emergency Department Urinary Antibiograms Differ by Specific Patient Group

“…Higher resistance rates were observed for ampicillin and gentamicin in the younger female cohort, possibly related to their higher frequency of use due to the former being a drug of choice in pregnancy and the latter generally being prescribed to younger patients in whom preexisting renal impairment is less frequent. SXT, historically considered a first-line antibiotic for UTI, showed relatively low susceptibility rates (53 to 73%) across all groups, in line with recent U.S. surveillance data documenting significant increases in SXT E. coli resistance rates over the past decade (14). Furthermore, as observed among our cohort, resistance rates are typically highest in younger adults, likely reflecting the selective pressure of years of use in the outpatient setting for uncomplicated UTI (14).…”

“…SXT, historically considered a first-line antibiotic for UTI, showed relatively low susceptibility rates (53 to 73%) across all groups, in line with recent U.S. surveillance data documenting significant increases in SXT E. coli resistance rates over the past decade (14). Furthermore, as observed among our cohort, resistance rates are typically highest in younger adults, likely reflecting the selective pressure of years of use in the outpatient setting for uncomplicated UTI (14).…”

ESBL-producing <i>Escherichia coli</i> and Its Rapid Rise among Healthy People

“…Urinary tract infection (UTI) is one of the most common community-acquired infections [4][5][6] , and fosfomycin has become one of the potent antimicrobials in treatment of Gram-negative bacterial infections 135) including UTI 136,137) due to the recent rapid increase in the prevalence of ESBL-producing and fluoroquinolone-resistant E. coli in the community as well as in clinical settings worldwide 15,17) . However, the plasmid-mediated fosfomycin resistance gene, fosA3, has emerged 138) and spread in both human and animal in several Asian countries [139][140][141] , especially in China [142][143][144] .…”

“…Worldwide proliferation of antimicrobial-resistant bacteria has become an urgent global concern [1][2][3] . Acquisition of antimicrobial resistance in human commensal bacteria such as Escherichia coli (E. coli) has become a general threat to public health 4) , because E. coli sometimes causes community-onset infectious diseases including urinary tract infections (UTIs) 5,6) even in healthy people, as well as in hospitalized immuno-compromised patients. Production of extended-spectrum β-lactamases (ESBLs) have also been becoming common in E. coli recovered from healthy people worldwide [7][8][9][10][11] , and it has become notable that almost all ES-BL-producing E. coli usually has acquired co-resistance to fluoroquinolones (FQs) and other several clinically important antimicrobials [12][13][14] .…”

Overexpression of target enzyme gene fabI and efflux pump decrease triclosan susceptibility in Escherichia coli

“…Over the past few decades, selfmedication and antibiotics misuse led to the increasing resistance in clinical practice. Even worse, some of E. coli isolates have been reported as multidrug-resistant (MDR) pathogens (generally considered non-susceptible to ≥ 3 antibiotic classes) [4,5], which makes the clinical treatments of infections caused by E. coli face a great challenge.…”