Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections

Community-acquired urinary tract infections (UTIs) are among the most commo n bacterial infections in women. Therapy for these infections is usually be gun before results of microbiological tests are known. Furthermore, in wome n with acute uncomplicated cystitis, empirical therapy without a pretherapy urine culture is often used. The rationale for this approach is based on t he highly predictable spectrum of etiologic agents causing UTI and their an timicrobial resistance patterns. However, antimicrobial resistance among ur opathogens causing community-acquired UTIs, both cystitis and pyelonephriti s, is increasing. Most important has been the increasing resistance to trim ethoprim-sulfamethoxazole (TMP-SMX), the current drug of choice for treatme nt of acute uncomplicated cystitis in women. What implications do these trends have for treatment of community-acquired UTIs? Preliminary data suggest that clinical cure rates may be lower among women with uncomplicated cystitis treated with TMP-SMX when the infecting p athogen is resistant to TMP-SMX. Women with pyelonephritis also have less b acterial eradication and lower clinical cure rates when treated with TMP-SM X for an infection that is resistant to the drug. Therefore, in the outpati ent setting, identifying risk factors for TMP-SMX resistance and knowing th e prevalence of TMP-SMX resistance in the local community are important ste ps in choosing an appropriate therapeutic agent. When choosing a treatment regimen, physicians should consider such factors as in vitro susceptibility , adverse effects, cost-effectiveness, and selection of resistant strains. Using a management strategy that takes these variables into account is esse ntial for maintaining the safety and efficacy of treatment for acute UTI.