title: Emerging resistance problems and future perspectives in pharmacotherapy for complicated urinary tract infections.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are among the most common infectious diseases and contribute to high financial burden worldwide. Administration of appropriate antibiotic therapy is the key to achieving good therapeutic outcomes. The authors review the current status of global or regional epidemiology, especially on the antimicrobial resistance and several potential agents against complicated UTIs by multidrug-resistant (MDR) pathogens.
  
  
  METHODS
  The authors summarized the susceptibility status on several major surveillance programs on uropathogens, focusing on Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. Besides, the current perspectives of several potential antimicrobials against MDR uropathogens available for UTIs were also reviewed.
  
  
  CONCLUSIONS
  High resistance to broad-spectrum antibiotics, especially to extended-spectrum β-lactams, carbapenems, and fluoroquinolones among uropathogens emerges as a critical problem in many countries. Appropriate antimicrobial stewardship and continuous surveillance are necessary to monitor the trends of susceptibility for main pathogens. For these MDR uropathogens, polymyxin, fosfomycin, tigecycline, nitrofurantoin, linezolid, and daptomycin might be potential treatments for patients with uncomplicated and complicated UTIs in some countries, although they might not be approved by their regulation. However, more clinical evidence and more extensive meta-analyses are needed to evaluate and confirm the effectiveness of their usage in countries with a high prevalence of multidrug resistance.
authors.affiliation: Kaohsiung Medical University, Kaohsiung Medical University Hospital, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan.
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D018579:Patient Selection; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents