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Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens

  1. Elizabeth B. Hirsch1,4
  1. 1Department of Pharmacy and Health Systems Sciences, Northeastern University
  2. 2Department of Medicine/Division of Infectious Diseases, Veterans Affairs Boston Healthcare System
  3. 3Department of Medicine/Division of Infectious Diseases, Boston University School of Medicine
  4. 4Department of Pharmacy
  5. 5Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  1. George M. Eliopoulos, Section Editor
  1. Correspondence: E. B. Hirsch, Department of Pharmacy and Health Systems Sciences, Northeastern University, 360 Huntington Ave, R218 TF, Boston, MA 02115 (e.hirsch{at}


Urinary tract infections (UTIs) are among the most commonly treated bacterial infections. Over the past decade, antimicrobial resistance has become an increasingly common factor in the management of outpatient UTIs. As treatment options for multidrug-resistant (MDR) uropathogens are limited, clinicians need to be aware of specific clinical and epidemiological risk factors for these infections. Based on available literature, the activity of fosfomycin and nitrofurantoin remain high for most cases of MDR Escherichia coli UTIs. Trimethoprim-sulfamethoxazole retains clinical efficacy, but resistance rates are increasing internationally. Beta-lactam agents have the highest rates of resistance and lowest rates of clinical success. Fluoroquinolones have high resistance rates among MDR uropathogens and are being strongly discouraged as first-line agents for UTIs. In addition to accounting for local resistance rates, consideration of patient risk factors for resistance and pharmacological principles will help guide optimal empiric treatment of outpatient UTIs.

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  • Received March 28, 2016.
  • Accepted June 8, 2016.
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