July 16, 2019

Why it's getting so much harder to treat UTIs

Daily Briefing

    Evidence shows that urinary tract infections (UTIs) are becoming increasingly resistant to the routine course of antibiotics, leading to more serious illnesses, increased hospitalizations, and "prolonged discomfort" for patients, Matt Richtel reports for the New York Times.

    Learn more: How to eradicate antibiotic overuse

    The rise of drug resistant UTIs

    Each year, millions of Americans contract UTIs, and most of those patients are women.

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    In the past, UTIs have been cured "easily and quickly" through a short course of antibiotics, but that's increasingly not the case, according to Richtel.

    The New York City Department of Health, for instance, recently found "sharp rises in resistance to gold standard treatments over the past decade and a half," Richtel writes. Specifically, the department found that one-third of the most common type of UTI—uncomplicated UTIs caused by E.coli—are resistant to Bactrim, one of the most commonly used treatments, and about one-fifth are resistant to five other common drug treatments.

    According to Richtel, physicians across the United States have stopped prescribing the drug ampicillin, which was once the most popular way to treat the infections, altogether because UTIs grew resistant to it. Now, some UTIs requiring intravenous antibiotics to clear.

    That makes otherwise healthy patients sicker

    Usually, patients with chronic medical conditions or weakened immune systems are most susceptible to drug-resistant infections, but UTIs "have a dubious distinction" of being "the single biggest risk to healthy people from drug-resistant germs," Richtel writes.

    That means, with the rise of antibiotic-resistant infections, more and more generally healthy patients are experiencing stubborn UTIs and prolonged symptoms.

    Carolina Barcelos, a postdoctoral researcher, had several UTIs when she was a teenager, which were successfully treated with Bactrim. But, when she got a UTI in February, Bactrim didn't work. She was prescribed nitrofurantoin, another antibiotic, four days later, which didn't work either. Finally, she was prescribed ciproflaxacin, which cleared the infection. A urine culture showed that the infection was susceptible to the third medication, but not the first two.

    "Next time, I'm going to ask them to do a culture right away," she said. "For eight days I was taking antibiotics that weren't working for me."

    The rise of antibiotic-resistant UTIs showcases a broader concern about antibiotic resistance: E. coli is not only proving resistant to individual antibiotics, but a group of drugs called beta-lactam antibiotics, Richtel reports.

    Brad Frazee, an ED doctor in California, treated a woman with this type of resistance at Highland Hospital. The woman ended up with a kidney infection and had to be treated intravenously with the drug ertapenem, which can cost $1,000 per dose.

    The solution

    Medical professionals believe the long-term solution to the issue of antibiotic resistance is a "continued push for more judicious use of antibiotics worldwide," Richtel writes. In the short term, he writes that researchers could develop a low-cost diagnostic tool that would allow physicians to perform instant urine cultures, so doctors can prescribe the right antibiotic.

    Meanwhile, although resistant UTIs are a growing concern, studies on the topic are "scarce," according to the World Health Organization. Currently, there are no national estimates on the number of deaths that occurred in the United States due to the infections, though CDC is looking to expand its research on the infections to promote a solution.

    Clifford McDonald, associate director for science in the division of health care quality promotion at CDC said, "If we don't do something soon, it's going to push all our treatments to more advanced antibiotics that finally put a lot of pressure on the last-line treatments" (Richtel, New York Times, 7/13 [1]; Richtel, New York Times, 7/13 [2]).

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