Impact of Changing Patterns of Antimicrobial Resistance in Uropathogens: Emerging Treatment and Strategies.

Urinary tract infection (UTI) is common, especially in women, and the microbiology of UTI is predictable. Over the past decade, numerous reports have documented increasing resistance among uropathogens to first-line agents for the treatment of UTI, especially trimethoprim/sulfamethoxazole (TMP/SMX). It is recommended that TMP/SMX should not be administered as empiric therapy for UTI in communities where resistance rates exceed 20%. However, reliable data regarding the true prevalence of resistance in a community are often lacking. Preliminary work has suggested that recent antimicrobial use is an important risk factor for infection with a TMP/SMX-resistant isolate. A better understanding of the epidemiology of resistance is needed to aid therapeutic decisions and devise interventions to reduce or slow emerging resistance.