ANTIBIOTIC RESISTANCE IN URINARY TRACT INFECTIONS: CURRENT PROBLEMS, ANTIMICROBIAL THERAPY STRATEGIES AND PREVENTION PROSPECTS

Abstract

Urinary tract infections (UTIs) are among the most common bacterial infections in humans and represent a significant source of medical care. Modern urology faces a fundamentally new challenge: the rapid spread of antibiotic-resistant uropathogens, primarily members of the Enterobacterales family, including strains producing extended-spectrum β-lactamases and carbapenemases. Complicated UTIs, urinary catheter-associated infections, recurrent infections, and infections in patients with urologic obstruction, stones, neurogenic bladder, and post-instrumentation procedures pose particular clinical challenges. The purpose of this review is to systematize current understanding of the causes of increasing antibiotic resistance in UTIs, analyze current principles of diagnosis and antibacterial therapy, and assess promising areas for prevention and reduction of antibiotic burden. Particular attention is paid to the principles of antimicrobial stewardship, personalized empirical therapy based on risk factors for resistant pathogens, the use of local antibiograms, early de-escalation of treatment, shortening the duration of antibiotic therapy, switching from intravenous to oral administration, and the development of non-antibiotic methods for relapse prevention. The scientific novelty of this review lies in the systematization of modern approaches to the problem of antibiotic resistance in urology as a unified clinical and organizational system that combines early diagnosis, risk stratification, personalized empirical therapy, microbiologically based de-escalation, control of the source of infection and antibiotic-sparing prophylaxis. A systemic approach to managing antibiotic resistance in urinary tract infections is proposed, combining stratification of individual risk of resistant uropathogens, local epidemiological information, early microbiological verification, targeted de-escalation of antibacterial therapy, control of the urological source of infection, and antibiotic-sparing prevention of relapse.