The resistance to antibiotics may not be detectable initially, but appears after a period of exposure to β-lactam antibiotics (during therapy or after). Other terms include “SPICE organisms” which include many Gram-negative bacteria that have inducible, chromosomal AmpC β-lactamase genes. The term “ESKAPE” was one of the former descriptions of pathogens that cause the majority of hospital infections while effectively “escaping” the effects of available therapeutics. An international panel of experts developed the following definitions: multidrug-resistant (MDROs) means acquiring nonsusceptibility to at least one agent in three or more antimicrobial categories, extensively drug-resistant (XDR) is nonsusceptible to at least one agent in all, but two or fewer antimicrobial categories, and pan-drug-resistant (PDR) isolates are nonsusceptible to any of the available antimicrobial classes. There are different confusing terminologies in addressing this process. Multiple mechanisms that enable the organism to become resistant include enzymatic transformation, modification of site of action, active efflux from the cell interior and, the prevention of entry of the molecules into the cell. Many urological procedures are complicated with such infectious manse, frustrating the surgeons and the patients.

Furthermore, bloodstream infections associated with severe complicated urinary tract infections (CUTIs) are associated with high mortality rates of 20–50% among critically ill patients. This resulted in prolonged hospital stay, marked increases in the cost as well as increase in morbidity and mortality. This crisis is mostly man-made as it is attributed to the overuse and misuse of these medications, as well as a lack of new drug development by the pharmaceutical industry seeking better profitable agents.

This has been a global challenge which has been identified by the World Health Organization as “one of the greatest threats to human health”. Over the past two decades, GNBs have developed complex mechanisms of resistance against most of the potent antibiotics. It has been estimated that 150 million people are diagnosed with UTI each year worldwide. Urinary tract infection is the second most common infectious presentation in community as well as in hospital settings. Both showed morbidity and mortality benefits. A critical step in managing these organisms is the early recognition and appropriate empiric therapy. When treating these infections, clinicians have few effective antimicrobials options. The latter group includes carbapenem-resistant Enterobacteriaceae (CRE), as well as Pseudomonas aeruginosa carbapenemases (CRP). In this chapter, we review the management of the most common and challenging group of resistant Gram-negative organisms, the extended-spectrum β-lactamases producing organisms (ESBL) and the carbapenem-resistant organisms (CRE/CRP). Furthermore, it increases the risks and complications of urological procedures. This resulted in prolonged hospital stay, marked increase in the cost as well as increase in morbidity and mortality. This has been a global challenge which has been identified by the World Health Organization as “one of the greatest threats to human health.” This crisis is mostly attributed to the overuse and misuse of these medications, as well as lack of new drug antimicrobials by the pharmaceutical industry. It is mostly caused by Gram-negative bacteria (GNBs). Urinary tract infection (UTI) is one of the most common infections in both the community as well in hospital settings.

Uti gram negative rods