[Clinical and practical aspects of multidrug-resistant pathogens]

Multidrug-resistant pathogens are the result of cumulative risk constellations and inappropriate antibiotic use. Multidrug-resistant Gram-negative bacteria are of particular relevance, especially in patients with prior antibiotic therapy, recurrent hospitalization, urinary drainage devices or a high density of invasive procedures. A central element of clinical management is the strict distinction between asymptomatic bacteriuria and clinically manifested urinary tract infections. Antimicrobial therapy is justified exclusively in the presence of a clinically manifested infection and, even in the context of multidrug resistance, must primarily be guided by the severity of the disease and the infection focus. In urology, the diagnostic work-up of multidrug-resistant pathogens primarily serves the risk stratification and treatment planning. Therapeutically, the principle of an initial empirical approach followed by targeted adjustment and de-escalation also applies to infections caused by multidrug-resistant organisms. In the perioperative setting, a known colonization with multidrug-resistant pathogens requires a differentiated, guideline-based risk assessment.