Bacterial resistance in urinary tract infections: how to stem the tide

Each year, approximately 10% of the population is diagnosed with a urinary tract infection (UTI). Escherichia coli is the most prevalent pathogen in UTIs but other species make significant contributions. UTIs are commonly treated with antibiotics and, therefore, a potential source for the emergence and/or selection of resistant bacteria. Although susceptibility to some antibiotics for a number of species is still high, resistance is an issue both for community- and hospital-acquired UTI. However, often treatment is empiric, especially in the community setting. This empiric treatment is often guided by inadequate information about the (local) rates of resistance, selection and emergence of resistance, although there is a general consensus that there is a relationship between antibiotic use and resistance. It is well known that some antibiotics, e.g., some fluoroquinolones, are able to induce mutations leading to resistance but the antibiotics prescribed also affect the commensal flora, potentially selecting resistant organisms. However, antibiotics meant to treat other infections may select uropathogens and, thereby, the risk for UTIs increases. The duration of treatment of any infection is an important factor to consider in this respect, as well as subinhibitory concentrations of the antibiotic prescribed. Prudent use of new and still effective antibiotics is required. Although prudent use of these antibiotics may help to reduce the prevalence of antibiotic-resistant uropathogens, elimination will be hard to achieve. Therefore, we believe, that we can reduce the tide but we will still have to deal with the resistance problem in the future.