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ABSTRACT
Introduction: Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare settings. A wide variety of bacteria are responsible for causing UTIs, however extra-intestinal pathogenic E. coli or ExPEC) remains the most common etiological agent. Since 2000, resistance to antibiotics emerged globally among ExPEC and is causing delays in appropriate therapy with subsequent increased morbidity and mortality.
Areas covered: The aim of this review article is to provide an overview on the definitions, etiology, treatment guidelines (including agents for infections due to antimicrobial resistant bacteria) of lower UTIs and to highlight recent aspects on antimicrobial resistance of ExPEC.
Expert commentary: For patients with acute uncomplicated lower UTIs, nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin or pivmecillinam should be prescribed for a 1-5 day course depending on the agent used. Single-dose fosfomycin is an excellent option for uncomplicated lower UTIs and has had similar clinical and/or bacteriological efficacy for 3- or 7-day regimens for alternate agents (i.e., ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin).
Declaration of interests
This paper was supported in part by a research grant from the Calgary Laboratory Services (grant number 10009392). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.