almost half of women Additionally, more than 1 in 10 men will develop a urinary tract infection (UTI) during their lifetime, and many experience recurrent UTIs. These common bacterial infections that can lead to painful urination have been easily treated and cured with antibiotics for decades.
However, as a result of antibiotic resistance, many antibiotics routinely used for urinary tract infections become ineffective when bacteria become resistant to the drugs used to treat them. It leads to serious illness, hospitalization, and death, driving up medical costs.
Antibiotic resistance occurs naturally, but the use and misuse of antibiotics in humans and domestic animals is accelerating resistance. A 2019 study found that over 92% of bacteria that cause UTIs are resistant to at least one common antibiotic, and almost 80% are resistant to at least two. Escherichia coli It is the most common cause of UTI.
“Antibiotic resistance is a big problem for UTIs compared to other infections because UTIs are so common. The effects are seen much more quickly and with higher prevalence.”
Drug-resistant urinary tract infections are the result of the larger problem of antimicrobial resistance (AMR). AMR occurs when bacteria, viruses, fungi, and parasites stop responding to drugs used to treat it. In 2019, about 4.95 million people died from AMR-related deaths, and at least 1.27 million died as a direct result of antibiotic-resistant infections, according to a 2022 study. lancet found. AMR killed more people than HIV and malaria in 2019, according to a study, and was the leading cause of death worldwide. In 2021, the World Health Organization (WHO) declared AMR one of the top 10 global public health threats facing humanity.
Bacteria that cause UTIs have become resistant for several reasons. One is selection pressure, explains Bebell. Theoretically, the right antibiotic, given in the right dose and for a long enough period of time, will kill all the bacteria it targets. If the dose is too low or the antibiotic is not taken long enough, the bacteria will be under selective pressure, but they will not be able to kill them completely. Those that survive will adapt and become more resistant.
Even when antibiotics are prescribed and used correctly, each time people take them they affect the composition of the bacteria in the body and put selective pressure on the bacteria that live in the gastrointestinal tract. Escherichia coli and other bacteria that cause UTIs. So, says Bebell, there is a relationship between taking antibiotics in general and the likelihood of developing a drug-resistant UTI later on.
Humans can also be exposed by eating animals, says an epidemiologist and WHO Global Antibiotics Research and Development Partnership, a non-profit organization dedicated to developing treatments for drug-resistant infections. Ramanan Laxminarayan, chairman of the GARDP, says they can get drug-resistant strains. Escherichia coli From eating improperly cooked meat. This bacterium causes intestinal disease and can lead to drug-resistant urinary tract infections.
If a urinary tract infection doesn’t respond to conventional antibiotics, your doctor will use broad-spectrum antibiotics. This is effective against a wider variety of bacteria. Often these are only available intravenously, requiring hospitalization, which can last from 5 to 14 days, and increases medical costs. . Some people have died from UTIs that spread to the bloodstream and caused sepsis, and drug-resistant infections could make this more common.
Bebell recently had a patient with a drug-resistant UTI who had to be hospitalized intermittently for months. She repeatedly cultured patients’ blood and urine to identify which bacteria were resistant to which antibiotics, allowing health care providers to determine the most effective treatments. This raises the question of whether routine bacterial cultures should become the standard for UTIs. An antibiotic is identified.
Bacterial cultures are likely to become more routine, especially in complex cases, but Bebell sees them as only a short-term solution. While important, he adds, it is costly and time consuming (takes one to five days) and can delay treatment. “We hope that more point-of-care tests will be developed to help identify relevant bacteria and their genetic make-up. I think it’s about not relying on any method based on it,” she says.
Bebell would like to see tests that can identify the dominant bacteria causing infections and determine if they have genetic mutations that indicate antibiotic resistance. Bebell says such a test is in development that he can perform in 15 minutes at a patient’s bedside with little training. However, she is unaware of any that are available for clinical use in urinary tract infections.
But better diagnostics alone won’t solve the problem. New therapeutic strategies are also needed. Last October, researchers found that the combination of cefepime and emetazobactam was effective in treating some drug-resistant UTIs. Emmetazobactam essentially prevents cefepime from being destroyed by enzymes produced by drug-resistant bacteria. Combining one drug with another to “protect” it is a common strategy, says Bebell. “It’s promising in the long run because that’s how we’ve been successful with a lot of combination antibiotics. But this particular antibiotic [combo] In that sense, I think it’s a short-term solution,” she says.
New antibiotics may help. But Lakshminarayan doesn’t believe that developing new drugs is the only answer to drug resistance. Drug resistance is a global problem with no easy solutions, he says. “In poultry and pig farming, we need to use less antibiotics. [using] Less antibiotics sprayed on trees. This will require improved infection control in hospitals. There are many,” says Lakshminarayan. “It’s not just a silver bullet—he does one thing and it’s done.”
“New antibiotics are coming. But they are very expensive,” he adds. “We are used to spending $5, $10, $20 on antibiotics. Do you really want to spend $5,000 on your next course of antibiotics? It’s going to put a huge strain on the health system, but that’s where we’re headed.”
When it comes to avoiding urinary tract infections, there aren’t many evidence-based strategies, says Bebell. (For example, drinking cranberry juice in particular does not show any clear benefit.) Evidence-based prevention is to keep your system flushed with fluids and to maintain regular genital hygiene. am. (Bevel advises against washing too much and says to avoid harsh soaps.
There are few evidence-based prevention strategies, Bebell says, so the focus should be on antibiotic management. It is about reducing overall antibiotic use and improving infection control in hospitals and health care settings, both in humans and in commercial agriculture. general public. The WHO says some simple strategies to avoid infection include “washing hands regularly, preparing food hygienically, avoiding close contact with sick people, [practicing] Safer sex and staying up to date on vaccinations. “
“Often we really need antibiotics, but we all need to be advocates. [proper] Antibiotic use, and everyone’s responsibility,” Bevel says. “And when patients see a doctor, he encourages them to ask at least one simple question: ‘Do you need this antibiotic?'”
