Susceptibility Testing and the Future of Complicated UTI Care

"Susceptibility Testing and the Future of Complicated UTI Care" closes the series with a look at where complicated UTI management is headed over the next five years.

Looking five years ahead, Dr. Gupta asks Dr. Pogue how complicated UTI management might evolve. Dr. Pogue predicts clinicians will start comparing older, dose-optimized-for-urine oral agents against the new systemically dosed option. That will happen even in scenarios he does not personally endorse, such as substituting it for a resistant organism where a narrower agent would traditionally apply. He expects that real-world experimentation, if studied carefully, will teach the field more about optimally managing complicated UTI orally overall. It will also test long-standing assumptions about historic oral agents that were never rigorously evaluated for systemic exposure. Dr. Gupta connects this to a broader shift toward individualized, technology-assisted prescribing. She envisions artificial intelligence eventually helping narrow drug and dose choices before a pharmacist finalizes the decision. Before closing, Dr. Nelson raises a practical gap: susceptibility testing for new agents typically lags several days behind availability. He credits manufacturers of the newer oral carbapenem, and an earlier, less prominent oral carbapenem, with trying to accelerate testing access, though most laboratories still face days of transit and processing delays. Dr. Gupta and Dr. Nelson discuss surrogate markers. Dr. Nelson favors ertapenem susceptibility as a logical proxy, but cautions that extended-spectrum beta-lactamase-producing Klebsiella and Escherichia coli show different minimum inhibitory concentration distributions. That means surrogacy needs validation through large real-world susceptibility databases rather than assumption. Dr. Kaye adds that local data, including early test strips obtained before a drug's formal availability, proved valuable with prior novel antibiotics. He believes the same approach could build clinician confidence in switching patients to the new oral option once local isolates show strong in vitro activity. Dr. Gupta closes the series by thanking the panel for a rich, informative discussion and thanking viewers for watching.

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