Antibiotic treatment of urinary tract infection and its impact on the gut microbiota

Gut microbiota are considered to be the source of uropathogenic Enterobacterales that can colonise the periurethral space and ascend to the bladder, causing a urinary tract infection (UTI). 1 Klein RD Hultgren SJ Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat Rev Microbiol. 2020; 18: 211-226 Crossref PubMed Scopus (116) Google Scholar Although broad-spectrum antibiotics are the cornerstone of UTI treatment, paradoxically, their use is a known risk factor for UTI by selecting uropathogens that can become resistant to common antibiotics. 1 Klein RD Hultgren SJ Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat Rev Microbiol. 2020; 18: 211-226 Crossref PubMed Scopus (116) Google Scholar , 2 Smith HS Hughes JP Hooton TM et al. Antecedent antimicrobial use increases the risk of uncomplicated cystitis in young women. Clinic Infect Dis. 1997; 25: 63-68 Crossref PubMed Scopus (68) Google Scholar New UTI treatment strategies with less of an effect on the ecological balance of the gut microbiota than the antibiotics currently available are therefore needed, to reduce the risk of recurrent UTI and minimise the selection of antimicrobial resistance. The clinical and microbiological efficacy of temocillin versus cefotaxime in adults with febrile urinary tract infection, and its effects on the intestinal microbiota: a randomised multicentre clinical trial in SwedenTemocillin was found to be less selective than cefotaxime of Enterobacterales with reduced susceptibility to third-generation cephalosporins, and it could therefore be a favourable alternative in the empirical treatment of febrile UTI. Use of this antibiotic could reduce hospital transmission and health-care-associated infections by these pathogens. Full-Text PDF