Recently the emergence of pan-resistant bacterial pathogens was published in The Lancet Infectious Disease, online August 11, 2010. In this study 107 enterobacteria isolates from UK, India and Pakistan harbouring a broad spectrum metallo-β- lactamase 1 (called New Delhi metallo-β-lactamase 1; NDM-1) were found to be highly resistant against most antibiotics.
Two Klebsiella isolates from the UK have been shown to be resistant against all available antibiotics. These isolates or the plasmids conveying resistance were shown to have been transferred also from country-to-country.
This is the true beginning of a post-antibiotic era, which will have a dramatic impact on our current urological practice. Enterobacteria are the most important species causing urinary tract infections (UTI). Most of the isolates harbouring this NDM-1 enzyme also were from community-acquired UTI.
Whereas in Gram-positive bacteria several new antibiotics are seen on the market, there will be no new antibiotics against Gram-negative pathogens in the foreseeable future which means a tremendous threat for urology. Missing new antibiotics in the pipeline, prudent antibiotic use and infection control are the only options to delay the development of antibiotic resistance. The European Section of Infection in Urology (ESIU) of the EAU therefore is carrying out an annual one-day Global Prevalence Study of Infection in Urology (GPIU) since 2003, which today has shown to be one of the largest international databases concerning healthcare-related UTI. This study enables each participating department to receive the surveillance of infections in its own centre and gain insights into the geographic variation of antibiotic resistance, which is ultimately important to design the individual department’s antibiotic policy.
These latest worrying developments should give infection control a much higher preference in urological practice and we hope that it is a stimulus for urological departments to take part in the GPIU study. The study has now been prolonged until 16 December 2010. More about the study design and the changes which were implemented in 2010 can be found in the latest issue of European Urology Today.
By Profs. F. M.E. Wagenlehner and T. E. Bjerklund-Johansen