title: [Urinary tract infections and antibiotic resistance].
abstract: Urinary tract infections (UTI) usually are monoinfections caused by the endogenous microflora including gram-negatives, such as Escherichia coli, or gram-positives, like enterococci. This allows for an empiric treatment of uncomplicated UTIs and a short duration of therapy to minimize the probability for the development of resistance. Resistance often is based upon mutations altering the drug target (sulfonamides, trimethoprim, fluoroquinolones, fosfomycin) or acquisition of resistance genes (beta-lactams). The latter can be collocated with other resistance genes on mobile genetic elements mediating multiple drug resistance. Such elements are part of the chromosome of the Escherichia coli clonal group A (cgA). The prevalence of resistance to nitrofurantoin and fosfomycin is below 6%, while that of sulfonamide/trimethoprim varies between 15 and 50% all over Europe. Resistance to fluoroquinolones and amoxycillin approximates 15 and over 30%, respectively. A value of >20% for the empiric treatment of uncomplicated UTIs is associated with a significantly increased duration of therapy suggesting alternative antibiotic regimens.
authors.affiliation: Pharmazeutische Biologie und Mikrobiologie, Department Chemie, Universität Hamburg, Bundesstrasse 45, 20146, Hamburg, Deutschland. heisig@chemie.uni-hamburg.de
authors.forename: P
authors.initials: P
authors.lastname: Heisig
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D006306:Health Surveys; D006801:Humans; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Obstet Gynecol Surv. 1989 May;44(5):399-406
references.pmid: 2657522
references.citation: Int J Antimicrob Agents. 2003 Oct;22 Suppl 2:65-72
references.pmid: 14527774
references.citation: Clin Microbiol Infect. 2008 Jan;14 Suppl 1:11-32
references.pmid: 18154525
references.citation: J Antimicrob Chemother. 1998 Sep;42(3):363-71
references.pmid: 9786476
references.citation: Nat Rev Microbiol. 2006 Aug;4(8):608-20
references.pmid: 16845431
references.citation: Prim Care. 2008 Jun;35(2):345-67, vii
references.pmid: 18486719
references.citation: J Antimicrob Chemother. 2009 Jan;63(1):1-4
references.pmid: 18957393
references.citation: Planta Med. 2001 Feb;67(1):3-12
references.pmid: 11270718
references.citation: Clin Microbiol Rev. 2009 Oct;22(4):664-89
references.pmid: 19822894
references.citation: Urology. 2006 Dec;68(6):1169-74
references.pmid: 17169640
references.citation: Am J Med. 2008 Oct;121(10):876-84
references.pmid: 18823859
references.citation: Int J Antimicrob Agents. 2006 Jun;27(6):468-75
references.pmid: 16713191
references.citation: Mutagenesis. 2009 Nov;24(6):465-9
references.pmid: 19762349
references.citation: Curr Opin Infect Dis. 2006 Feb;19(1):67-71
references.pmid: 16374221
references.citation: J Antimicrob Chemother. 2003 Jan;51(1):69-76
references.pmid: 12493789
references.citation: Lancet. 2001 Apr 28;357(9265):1325-8
references.pmid: 11343738
references.citation: Antimicrob Agents Chemother. 2009 Jun;53(6):2283-8
references.pmid: 19364861