Department of Urology, Imperial College Healthcare NHS Trust, St Mary’s Hospital, Praed Street, London, W2 1NY, UK
The development of guidelines for management of urinary tract infections has helped toward some standardization in this diverse field, though it is becoming increasingly apparent how limited our antibiotic armamentarium is becoming, through the development of resistant bacteria. Clearly new treatment strategies are needed (e.g., vaccination), and we await clinical trials to test such novel therapies which are much needed.
Bacteria have existed for several million years, and therefore the discovery of penicillin in the past century would seem to be a footnote in history, and the development of subsequent antibiotic resistance appears like a postscript. The widespread application of antibiotics incorporates prophylactic and therapeutic regimes to manage urinary tract infections, both community-acquired and nosocomial in origin.
Guidelines are developed by specialist organizations which could perhaps address the different challenges for UTIs in the community and in the hospital setting, and while local variations will always exist, a global perspective (e.g., through international databases, such as that exemplified by the Working Group for UTI in the European Association of Urology) would be particularly useful. Antibiotic prophylaxis before surgery has been adopted as a universally accepted principle, and therefore, such knowledge would help rationalize and optimize treatment regimens.
Future research in this field may include strategies against recurrent infections (e.g., vaccines [1, 2]), minimizing antibiotic resistance (possibly as a public health intervention, in the laboratory, or likely both), identifying the genetic predisposition to recurrent infections, and further development of technologies to deliver antimicrobial treatments (e.g., drug-eluting stents or other devices).
In some ways, a short book such as this can answer some of the basic questions of how best to manage UTIs, but hopefully readers will also be sufficiently challenged to enquire how to improve care in certain conditions and be stimulated into perhaps even finding the solutions.
Zakri RH, Dasgupta R, Dasgupta P, Khan MS. Preventing recurrent urinary infections: role of vaccines. BJU Int. 2008;102(9):1055–6.PubMedCrossRef
Zaffanello M, Malerba G, Cataldi L, et al. Genetic risk for recurrent UTIs in humans: a systematic review. J Biomed Biotechnol. 2010.