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    Treating UTIs in the age of antibiotic resistance: Strategies for the practicing OB/GYN

     

    Summary

    It is likely that ob/gyns will encounter MDR pathogens previously seen only in the critical care areas that will now occur in both the inpatient and outpatient obstetrical settings. Previous exposure to antibiotics, hospitalization, and the presence of an indwelling catheter increase the risk of resistant organisms. As antibiotic resistance is becoming more widespread, awareness of antibiotic sensitivities and consultation with infectious disease specialists in cases of MDR infections will help practitioners to provide optimum care in these difficult cases. In cases of ESBL-associated UTIs, it is important to obtain a test of cure 10 to 14 days after treatment to confirm eradication of the infection. Carbapenems, fosfomycin, and newer cephalosporin/beta-lactamase inhibitors appear safe for use in pregnancy and provide activity against ESBL-producing Enterobacteriaceae that are resistant to our previously used therapies. Strategies such as good handwashing, contact precautions when dealing with patients with resistant organisms, and appropriate antibiotic stewardship (limiting the use of unnecessary antibiotics, limiting broad-spectrum antibiotics when a narrow agent is available, institutional antibiotic cycling) will help us to better deal with these infections in the future.

    Take-home points

    MDRO urinary tract infections are now being seen in the community at higher frequencies with ESBL-producing E coli increasing from 7.8% to 18.9% in the US from 2010 to 2014.

    Consider antibiotic resistance for infections that do not respond to conventional therapy.

    Be knowledgeable of  local antibiograms when treating UTIs empirically. Obtain culture and sensitivities studies on all patients at higher risk for antibiotic resistance.

     

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    Christopher Hicks, MD
    Dr Hicks is Resident in the Department of Obstetrics and Gynecology, Bridgeport Hospital, Bridgeport, Connecticut.
    Zane Saul, MD
    Dr Saul is Chief, Section of Infectious Disease, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut, and ...

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