Context: The significant global upsurge in antimicrobial resistance, particularly among Enterobacteriaceae, represents a serious threat to health care systems. The implications for urologic practice are of particular concern.
Objective: To review trends in antibiotic resistance in urologic practice.
Evidence acquisition: We report current European trends of resistance in Gram-negative uropathogens.
Evidence synthesis: In addition to β-lactam resistance, Gram-negative pathogens are often resistant to multiple drug classes, including aminoglycosides, fluoroquinolones, and carbapenems, commonly used to treat urologic infections. Interest is renewed in old antibiotics, and several new antibiotics are in the pipeline to meet the challenge of treating these infections. In this review, we summarise emerging trends in antimicrobial resistance and its impact on urologic practice. We also review current guidelines on the treatment and prevention of urologic infections with these organisms, and some key antibiotics in the era of resistance.
Conclusions: Increasing antimicrobial resistance represents a challenge to urologic practice for both treatment and prophylaxis. Antibiotic choice should be determined according to risk factors for multidrug resistance. Good knowledge of the local microbial prevalence and resistance profile is required to guide antimicrobial therapy.
Patient summary: Antimicrobial resistance represents a challenge in urology. We summarise emerging trends in antimicrobial resistance and review current guidelines on the treatment and prevention of urologic infections, as well as some key antibiotics in the era of resistance.
Keywords: Acute pyelonephritis; Antimicrobial resistance; Catheter-associated urinary tract infection; Complicated urinary tract infection; Prostatitis; Transurethral prostate biopsy; Uncomplicated urinary tract infection; Urologic infections.
Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.