Update in Adult Urinary Tract Infection

Abstract

Urinary tract infection remains a common problem for many populations. Recent studies have expanded our understanding of the host innate immune response and its role in the familial association observed for recurrent uncomplicated urinary tract infection in healthy women. Therapeutic management for uncomplicated infection has been compromised by increasing antimicrobial resistance, particularly global dissemination of the CTXM-15 extended spectrum β-lactamase (ESBL) producing Escherichia coli ST-131 strain. Prevention strategies exploring non-antimicrobial approaches continue to show limited promise, and approaches to limit empiric antimicrobials are now being explored. For complicated urinary tract infection, increasing antimicrobial resistance limits therapeutic options for many patients. In addition to ESBL producing E. coli, NDM-1 E. coli and Klebsiella pneumoniae and other resistant Gram negatives, such as Acinetobacter species, are being isolated more frequently. There has been renewed interest in catheter-acquired urinary tract infection, the most common health-care associated infection, with several recent evidence-based guidelines for infection prevention available. However, technologic progress in development of adherence-resistant catheter materials remains disappointing.

Sepsis: Antimicrobial Therapy

“…Urosepsis, in general, is easily diagnosed by positive urine and blood cultures with the same pathogens, but until microbiological results are available, empirical treatment should be selected considering the pharmacokinetics of the agent, its spectrum of activity relative to the anticipated pathogens and potential for adverse effects. Therapeutic management for uncomplicated infection has been compromised by increasing antimicrobial resistance, particularly global dissemination of the CTXM-15 extended spectrum β-lactamase (ESBL) producing Escherichia coli ST-131 strain (31).Guidelines developed by the Infectious Diseases Society of America (IDSA) and the European Society for Microbiology and Infectious Diseases (ESCMID) (32) recommends that women with pyelonephritis requiring hospitalization may be initially treated with an intravenous antimicrobial regimen, such as a fluoroquinolone (ciprofloxacin, ofloxacin) when the prevalence of resistance of community uropathogens is not known to exceed 10%. If the prevalence of fluoroquinolone resistance is thought to exceed 10%, an initial intravenous dose of a long-acting parenteral antimicrobial, such as ceftriaxone or a consolidated 24-h dose of an aminoglycoside (gentamicin), with or without ampicillin, an aminoglycoside (gentamicin), with or without ampicillin or an extended-spectrum penicillin (piperacillin, mezlocillin), with or without an aminoglycoside, or a carbapenem (imipenem, meropenem) is recommended.…”

Evaluation of the Hungarian ambulatory antibacterial use in urinary tract infections with different methods

“… non-modifiable risk factors: gender; age; genetic; congential abnormalities  modifiable or behavioral risk factors: use of diaphragms, condom/spermicides for contraception; frequency of sexual intercourse; previous episode of UTI; poor hygenic conditions [140,[147][148][149].…”

“…In South Korea the resistance rates of E.coli increased from coli and K. pneumoniae and other resistant Gram negatives are being isolated more frequently from outpatient samples [149].…”

“…Nowadays ESBL-producing strains are appearing and causing uncomplicated UTI more frequently in outpatient settings among previously healthy individuals [149,216,233].…”

“…Therefore, for empiric therapy of frequent uncomplicated cystitis fosfomycintrometamol, nitrofurantoin or pivmecillinam (not listed in the USA and many European countries including Hungary) may represent good options as first-line antibiotics [149,151,214,249,250].…”