Antibiotic Resistance and Novel Antibiotics for the Treatment of Urinary Tract Infections

Surveillance data on antibiotic resistance need to be considered with respect to the origin of isolates, types of surveillance studies, and types of types of registered infections. Antibiotic resistance in gram-negative uropathogens has been investigated in both local and multinational studies. A compilation of worldwide studies for example showed resistance rates of gram-negative uropathogens against fluoroquinolones in 10% to 80%, against cephalosporines in 5% to 70% and against carbapenems in 0% to 35%. A specific surveillance study in the field of urology—the global prevalence of infections in urology (GPIU) study—is a point prevalence study with a global effort to create surveillance data in patients at various urological departments with health-care associated urogenital infections (HAUTIs). The GPIU study has been performed annually since 2003, with a total inclusion of 27,542 patients, thus far. Resistance rates of most uropathogens against all tested antibiotics were high, especially with multidrug resistance. A concerning finding was that the severity of HAUTI is also increasing—25% being urosepsis in recent years. In order to keep up with this alarming trend, novel antibiotics for the treatment of urinary tract infections need to be developed. Several strategies are currently employed: Beta-lactam/beta-lactamase inhibitor combinations are extended to cephalosporines and carbapenems. Novel fluroroquinolones have been developed, and so called siderophore antibiotics are being tested. Novel aminoglycosides and novel tetracyclines are also in the clinical development phases. Thus, several antibiotic substances are currently being developed, or in the late clinical phases of development.