title: 'Pre-emptive culturing' will improve the chance of 'getting it right' when empirical therapy of urinary tract infections fails.
abstract: Antibiotic resistance is increasing and beginning to affect the outcome of empirical antimicrobial therapy of urinary tract infections. Associated resistance, i.e. the fact that a bacterium resistant to one antibiotic is often much more likely to be resistant to other antibiotics, drastically decreases our chances of getting a second empirical attempt right. To increase the use of narrow-spectrum antibiotics, which are considered to be less selective for resistance, we need to develop new strategies from the laboratory to support our clinical colleagues. We suggest that 'pre-emptive culturing' of urine (i.e. a culture obtained before empirical treatment is instituted) will prevent clinicians from making a second improper empirical choice or having to resort to expensive broad-spectrum antimicrobials, which may drive resistance further. This strategy will be especially important in settings with high levels of resistance.
authors.affiliation: Department of Clinical Microbiology, Central Hospital, Växjö, Sweden. martin.sundqvist@ltkronoberg.se
authors.forename: Martin
authors.initials: M
authors.lastname: Sundqvist
authors.forename: Gunnar
authors.initials: G
authors.lastname: Kahlmeter
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents