JAC Advance Access originally published online on May 19, 2009
Journal of Antimicrobial Chemotherapy 2009 64(2):227-228; doi:10.1093/jac/dkp181
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Leading articles |
‘Pre-emptive culturing’ will improve the chance of ‘getting it right’ when empirical therapy of urinary tract infections fails
1 Department of Clinical Microbiology, Central Hospital, Växjö, Sweden 2 Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital, Uppsala University, Uppsala, Sweden 3 Department of Medical Sciences, Section of Clinical Bacteriology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
* Corresponding author. Tel: +46470-587478; Fax: +46470-587455; E-mail: martin.sundqvist{at}ltkronoberg.se
Antibiotic resistance is increasing and beginning to affect the outcome of empirical antimicrobial therapy of urinary tract infections. Associated resistance, i.e. the fact that a bacterium resistant to one antibiotic is often much more likely to be resistant to other antibiotics, drastically decreases our chances of getting a second empirical attempt right. To increase the use of narrow-spectrum antibiotics, which are considered to be less selective for resistance, we need to develop new strategies from the laboratory to support our clinical colleagues. We suggest that ‘pre-emptive culturing’ of urine (i.e. a culture obtained before empirical treatment is instituted) will prevent clinicians from making a second improper empirical choice or having to resort to expensive broad-spectrum antimicrobials, which may drive resistance further. This strategy will be especially important in settings with high levels of resistance.
Keywords: antibiotic resistance , associated resistance , future strategies