Antibiotics 2014, 3(3), 375-377; doi:10.3390/antibiotics3030375

Editorial
Urinary Tract Infections
Truls E. Bjerklund Johansen 1 and Kurt G. Naber 2,*
1
Urology Department, Oslo University Hospital, 0424 Oslo, Norway
2
Urology Department, Technical University of Munich, Munich 81675, Germany
*
Author to whom correspondence should be addressed; E-Mail: kurt@nabers.de; Tel.: +49-9421-33369.
Received: 16 July 2014 / Accepted: 23 July 2014 / Published: 14 August 2014

Urinary tract infections (UTI) are among the most frequently acquired infections in the community, but also in hospitals and other health care institutions, causing a huge amount of antibiotic consumption. During the last decade we have seen significant changes in the field of urinary tract infections regarding causative pathogens and antibiotic treatment calling for an update of current trends.

The worldwide increase of uropathogens resistant to former first line antibiotics, such as cotrimoxazole, fluoroquinolones and cephalosporins, has had detrimental consequences not only for treatment but also for prophylaxis of infectious complications after urological interventions. A paradigm shift concerning asymptomatic bacteriuria has had a great impact on the definition and management of UTIs today [1,2,3,4].

For uncomplicated lower UTI, such as acute cystitis in otherwise healthy women, not only a revival of old (oral) antibiotics, such as fosfomycin trometamol, pivmecillinam, nitrofurantoin, can be observed in many guidelines [5,6,7], but even a non-antimicrobial measure has been tested in a pilot study [8]. It will therefore be interesting to see the results of forthcoming phase III studies and whether antibiotic therapy could at least be partially replaced. For prophylaxis of recurrent episodes of uncomplicated UTI, non-antimicrobial measures are already preferred and antimicrobial prophylaxis is only recommended as a last resort [7].

However, for complicated, nosocomial and severe UTI including pyelonephritis, antibiotic therapy will still be a corner stone in combination with treatment of the underlying complicating conditions. Unfortunately, there are few new antimicrobial drugs in the pipelines of pharmaceutical companies with prospects to overcome the problem of multi and extended drug resistant uropathogens [9].

Although the classical distinction between uncomplicated and complicated UTI is still valid in principle, the different criteria to be considered are so heterogeneous, that a better (phenotypical) subclassification might be helpful, as proposed by the European Section of Infection of Urology (ESIU) of the European Association of Urology (EAU) [10].

In consideration of so many new aspects related to optimal management of UTI, it has been our pleasure to edit a joint presentation of the results from different research groups in one special scientific publication challenging established as well as new scientific approaches to improve prophylaxis and treatment of patients suffering from UTI.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Naber, K.G.; Schito, G.; Botto, H.; Palou, J.; Mazzei, T. Surveillance study in Europe and Brazil on clinical aspects and antimicrobial resistance epidemiology in females with cystitis (ARESC): implications for empiric therapy. Eur. Urol. 2008, 54, 1164–1178, doi:10.1016/j.eururo.2008.05.010.
  2. Tandogdu, Z.; Cek, M.; Wagenlehner, F.; Naber, K.; Tenke, P.; van Ostrum, E.; Bjerklund Johansen, T. Resistance patterns of nosocomial urinary tract infections in urology departments: 8-Year results of the global prevalence of infections in urology study. World J. Urol. 2014, 32, 791–801, doi:10.1007/s00345-013-1154-8.
  3. Wagenlehner, F.M.E.; van Oostrum, E.; Tenke, P.; Tandogdu, Z.; Cek, M.; Grabe, M.; Wullt, B.; Pickard, R.; Naber, K.G.; Pilatz, A.; et al. Infective complications after prostate biopsy: Outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011. A prospective multinational multicentre prostate biopsy study. Eur. Urol. 2013, 63, 521–527.
  4. Wagenlehner, F.M.E.; Naber, K.G. Asymptomatic bacteriuria—Shift of paradigm. Clin. Infect. Dis. 2012, 55, 778–780, doi:10.1093/cid/cis541.
  5. Gupta, K.; Hooton, T.M.; Naber, K.G.; Wullt, B.; Colgan, R.; Miller, L.G.; Moran, G.J.; Nicolle, L.E.; Raz, R.; Schaeffer, A.J.; et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin. Infect. Dis. 2011, 52, e103–e120, doi:10.1093/cid/ciq257.
  6. Wagenlehner, F.M.E.; Hoyme, U.; Kaase, M.; Fünfstück, R.; Naber, K.G.; Schmiemann, G. Clinical practice guidelines: Uncomplicated urinary tract infections. Dtsch. Arztebl. Int. 2011, 108, 415–423.
  7. Grabe, M.; Bjerklund-Johansen, T.E.; Bartoletti, R.; Çek, M.; Naber, K.G.; Pickard, R.S.; Tenke, P.; Wagenlehner, F.; Wullt, P. Guidelines on urological infections. European Association of Urology 2014. Available online: http://www.uroweb.org/gls/pdf/19%20Urological%20infections_LR.pdf (accessed on 13 July 2014).
  8. Bleidorn, J.; Gagyor, I.; Kochen, M.M.; Wegscheider, K.; Hummers-Pradier, E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection?—Results of a randomized controlled pilot trial. BMC Med. 2010, 8, e30, doi:10.1186/1741-7015-8-30.
  9. Magiorakos, A.P.; Srinivasan, A.; Carey, B.; Carmeli, Y.; Falagas, M.E.; Giske, C.G.; Harbarth, S.; Hindler, J.F.; Kahlmeter, G.; Olsson-Liljequist, B.; et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012, 18, 268–281, doi:10.1111/j.1469-0691.2011.03570.x.
  10. Bjerklund Johansen, T.E.; Botto, H.; Cek, M.; Grabe, M.; Tenke, P.; Wagenlehner, F.M.E.; Naber, K.G. Critical review of current definitions of urinary tract infections and proposal of an EAU/ESIU classification system. Int. J. Antimicr. Agents 2011, 38S, 64–70.
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