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Nat Rev Urol. 2015 Oct;12(10):570-84. doi: 10.1038/nrurol.2015.199. Epub 2015 Sep 1.

The emerging threat of multidrug-resistant Gram-negative bacteria in urology.

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The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane Hospital, Herston, QLD 4006, Australia.
Division of Infectious Diseases, National University Health System, 1E Kent Ridge Road, 119228, Singapore.
School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, G. B. Grassi 74, 20157 Milan, Italy.
Department of Pathology, University of Otago, 23A Mein Street, Newtown, Wellington 6242, New Zealand.


Antibiotic resistance in Gram-negative uropathogens is a major global concern. Worldwide, the prevalence of Enterobacteriaceae that produce extended-spectrum β-lactamase or carbapenemase enzymes continues to increase at alarming rates. Likewise, resistance to other antimicrobial agents including aminoglycosides, sulphonamides and fluoroquinolones is also escalating rapidly. Bacterial resistance has major implications for urological practice, particularly in relation to catheter-associated urinary tract infections (UTIs) and infectious complications following transrectal-ultrasonography-guided biopsy of the prostate or urological surgery. Although some new drugs with activity against Gram-negative bacteria with highly resistant phenotypes will become available in the near future, the existence of a single agent with activity against the great diversity of resistance is unlikely. Responding to the challenges of Gram-negative resistance will require a multifaceted approach including considered use of current antimicrobial agents, improved diagnostics (including the rapid detection of resistance) and surveillance, better adherence to basic measures of infection prevention, development of new antibiotics and research into non-antibiotic treatment and preventive strategies.

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