Abstract
Uncomplicated urinary tract infections are typically monobacterial and are predominantly caused by Escherichia coli. Although several effective treatment options are available, the rates of antibiotic resistance in urinary isolates of E. coli have increased during the last decade. Knowledge of the actual local rates of antibiotic resistant pathogens as well as the underlying mechanisms are important factors in addition to the geographical location and the health state of the patient for choosing the most effective antibiotic treatment. Recommended treatment options include trimethoprim alone or in combination with sulfamethoxazol, fluoroquinolones, β-lactams, fosfomycin-trometamol, and nitrofurantoin. Three basic mechanisms of resistance to all antibiotics are known, i.e., target alteration, reduced drug concentration and inactivation of the drug. These mechanisms—alone or in combination—contribute to resistance against the different antibiotic classes. With increasing prevalence, combinations of resistance mechanisms leading to multiple drug resistant (mdr) pathogens are being detected and have been associated with reduced fitness under in vitro situations. However, mdr clones among clinical isolates such as E. coli sequence type 131 (ST131) have successfully adapted in fitness and growth rate and are rapidly spreading as a worldwide predominating clone of extraintestinal pathogenic E. coli.
Highlights
Uncomplicated urinary tract infections are among the most common infectious diseases in the community and occur in patients without any anatomic or functional abnormality
These data are derived from designed studies which have to be interpreted with caution: First, usually no microbiological testing is performed for patients suffering from uncomplicated urinary tract infections
The aim of this review is to provide an overview of epidemiology and mechanisms of resistance for antibiotics frequently used in the treatment of uncomplicated urinary tract infections
Summary
Uncomplicated urinary tract infections are among the most common infectious diseases in the community and occur in patients without any anatomic or functional abnormality. Similar frequencies for E. coli are reported by the ARESC study [5] and the findings by Dong Sup Lee et al [6] In addition, these aforementioned studies report 3.4% and 2.3% P. mirabilis, 4.1% and 5.6% Enterococci, 3.5% and 4.7% K. pneumoniae, 1.1% and 2.3% Enterobacter spp., other bacteria were found with 11.2% and 7%, respectively. These data are derived from designed studies which have to be interpreted with caution: First, usually no microbiological testing is performed for patients suffering from uncomplicated urinary tract infections. The aim of this review is to provide an overview of epidemiology and mechanisms of resistance for antibiotics frequently used in the treatment of uncomplicated urinary tract infections
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