title: Urological infections due to multidrug-resistant bacteria: what we need to know?
abstract: OBJECTIVE
  Recent epidemiological data have confirmed the increasing problem of antimicrobial resistance not only for hospitalized, healthcare-associated patients, but also for outpatients. In particular, the progressive increase in resistance to broad-spectrum antibiotics, such as third-generation cephalosporins, fluoroquinolones or carbapenems in Enterobacteriaceae, is an alarming situation for all urologists and general practitioners. Here, we aimed to review the epidemiological data of multidrug-resistant bacteria in the urological setting, in order to summarize all diagnostic and therapeutic recommendations to use in everyday clinical practice.
  
  
  METHODS
  We collected all recent publications from Medline and Cochrane Library from January 2000 to December 2013. Moreover, data from the abstracts presented at the EAU and AUA Congresses during the last 5 years have also been analyzed. All papers were evaluated by an expert panel on urological infections on behalf of the Italian Urological Association (SIU).
  
  
  RESULTS
  Fluoroquinolone and other antibiotic-resistant bacteria prevalence is normally very high in the lower urinary tract infection patients. In particular, multidrug-resistant bacteria prevalence in urological practice contributes to infectious morbidity increasing the financial costs to healthcare system. The expert panel on urological infections on behalf of the Italian Urological Association formulated new diagnostic pathway and therapeutic protocol in patients affected by urological tract infections due to multidrug-resistant bacteria.
  
  
  CONCLUSIONS
  The recent emergence of multidrug-resistant pathogens is an alarming public health issue also in urological practice with socioeconomic importance. Our practice should be revised on the basis of these new acquisitions.
authors.affiliation: Department of Urology, Santa Chiara Hospital, Trento - Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.affiliation: Department of Urology, Sant'Andrea Hospital, Faculty of Health Sciences, Sapienza University, Rome - Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan - Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine - Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pea
authors.affiliation: Department of Preclinical and Clinical Pharmacology, University of Florence, Florence - Italy.
authors.forename: Teresita
authors.initials: T
authors.lastname: Mazzei
authors.affiliation: Department of Infectious Diseases, University of Verona, Verona - Italy.
authors.forename: Ercole
authors.initials: E
authors.lastname: Concia
authors.affiliation: Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari - Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
authors.affiliation: Department of Urology, University Federico II, Naples - Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D017410:Practice Guidelines as Topic; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents