title: Aetiology and antibiotic resistance issues regarding urological procedures.
abstract: There are specific indications in urological procedures [transurethral resection of the prostate (TURP), transurethral resection of the bladder (TURB), endoscopic procedures, and all interventions classified as contaminated or dirty] requiring antibiotic prophylaxis. Most postoperative infections are caused by enterococci of the Gram-positive strains and Enterobacteriaceae of the Gram-negative ones. As reported by the European Center for Disease Prevention and Control (ECDC), there are increasing numbers of antibiotic-resistant pathogens. Most Enterococcus faecium strains are ampicillin-resistant and the Enterobacteriaceae have a high prevalence of extended-spectrum beta-lactamase (ESBL) producers, for which the cephalosporins and penicillins are not drugs of choice. In recent years, there are also increasing numbers of Gram-negative strains that are able to produce carbapenemases and for which the only therapeutic options are gentamicin, tigecycline and colistin. An alternative to these drugs, from a prophylactic point of view, is fosfomycin, an old antibiotic that maintains bactericidal activity against both enterococci and multidrug-resistant Enterobacteriaceae. Available in an oral formulation as trometamol salt, fosfomycin reaches high plasma and urine concentrations, and is therefore a possible alternative to other drugs both for therapy and urological prophylaxis.
authors.forename: Ercole
authors.initials: E
authors.lastname: Concia
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Azzini
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D004352:Drug Resistance, Microbial / Q000502:physiology*; D006801:Humans; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis,; Drug resistance,; Fosfomycin trometamol; Urological surgery,