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Optimal Care of Complicated UTIs

CE / CME

You’re in the Know: Laying the Foundation for Optimal Care of Complicated UTIs

Pharmacists: 1.00 contact hour (0.1 CEUs)

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Released: December 31, 2025

Expiration: December 30, 2026

Nicolás Cortés-Penfield
Nicolás Cortés-Penfield, MD, FACP, FIDSA
CME/CE Information

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Global Impact of Antimicrobial Resistance: 2019

The considerable challenges of cUTI may be even further exacerbated with rising rates of antimicrobial resistance in complicated UTI. Considering the global impact of antimicrobial resistance more broadly, an estimated 5 million deaths in 2019 were associated with antimicrobial resistance, including 1.27 million deaths that were directly attributable to antimicrobial resistance.5

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Resistance Among Gram-Negative Pathogens

Antimicrobial resistance is rising among gram-negative uropathogens. Infections with multidrug-resistant organisms are associated with longer time to effective therapy, increased use of IV antibiotics, greater cost, greater drug toxicity and higher rates of treatment failure.6  

In particular, the ESBL-producing uropathogens have become much more prevalent in this century, and they now represent approximately one fifth of cUTIs, significantly limiting treatment options. Overall, ESBL prevalence is one of the primary drivers of the burden of complicated UTI in the United States.6

What is a major issue contributing to the burden of complicated urinary tract infections (cUTIs) in patients and the healthcare system?

Financial Burden of Antimicrobial Resistance

Antimicrobial resistance also imposes substantial financial hardship on patients and contributes significantly to excess healthcare costs. According to average wholesale pricing of 4 different drugs used to treat cUTI in the United States, a standard 7-day treatment could cost as little as $5 or more than $10,000, depending on what drugs can be used.7

Thus, stemming the tide of antimicrobial resistance would make a huge difference in healthcare costs for millions of people each year, in the United States alone.

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IDSA Gram-Negative Resistance Categories: 2023

In terms of understanding antimicrobial resistance, there are a number of clinically important gram-negative resistance patterns.8

As touched on previously, ESBL-producing Enterobacterales are on the rise in the United States. Other phenotypes that HCPs are likely to encounter are listed here, including Stenotrophomonas maltophilia, which is inherently resistant to a number of antimicrobials.6,8

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Carbapenem-Resistant Enterobacterales Resistance

Taking a closer look at carbapenem-resistant Enterobacterales phenotypes, there are 2 main categories.

The noncarbapenemase-producing resistance phenotypes have multifactorial resistance mechanisms, based on production of other β-lactamases, increased efflux pump activity, and decreased permeability of the cell membrane to the β-lactams. Altogether, these factors generally produce lower-level resistance.9-11

The carbapenemase-producing uropathogens have been on the rise in the last couple decades. These come in a few different classes, which is important for antimicrobial selection. Here in the United States, the Klebsiella pneumoniae carbapenemase gene is the most common carbapenemase gene, which produces a class A carbapenemase, although the incidence of NDM has been increasing. Altogether, this whole category of carbapenemase-producing bacteria often have much higher level resistance to carbapenems and to other β-lactams, making them even more challenging to treat.9-12

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