'Pre-emptive culturing' will improve the chance of 'getting it right' when empirical therapy of urinary tract infections fails.

Antibiotic resistance is increasing and beginning to affect the outcome of empirical antimicrobial therapy of urinary tract infections. Associated resistance, i.e. the fact that a bacterium resistant to one antibiotic is often much more likely to be resistant to other antibiotics, drastically decreases our chances of getting a second empirical attempt right. To increase the use of narrow-spectrum antibiotics, which are considered to be less selective for resistance, we need to develop new strategies from the laboratory to support our clinical colleagues. We suggest that 'pre-emptive culturing' of urine (i.e. a culture obtained before empirical treatment is instituted) will prevent clinicians from making a second improper empirical choice or having to resort to expensive broad-spectrum antimicrobials, which may drive resistance further. This strategy will be especially important in settings with high levels of resistance.