- Experts say urinary tract infections (UTIs) are becoming difficult to treat because they’re becoming resistant to antibiotics.
- If untreated, UTIs can lead to more serious issues, including kidney infections.
- Some experts say UTI resistance is already becoming a “huge public health issue” in places such as Southeast Asia.
- Bacterial resistance is one of the top concerns right now for infectious disease specialists.
There was once a time when a UTI meant a quick trip to the doctor, a course of antibiotics, and an improvement in symptoms within 48 hours.
These days, it’s not always so simple.
A UTI is considered one of the
But experts say infections once regarded as simple to treat are becoming more resistant to antibiotics.
“This has been progressively the case over the last 20 to 25 years. When I was starting in medicine, you wouldn’t have to think very much about which antibiotics to use if particularly a woman had a UTI. The germs were all quite susceptible to the antibiotics. You could use a very simple antibiotic and illicit a cure,” Dr. William Schaffner, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Tennessee, told Healthline.
“Now we see antibiotic resistance affecting even these simple, straightforward infections, making treatment very difficult. Some of these women come back after two or three days and say, ‘Your antibiotic is not affecting me at all,’” Schaffner said.
UTIs occur when bacteria infect the urinary tract.
This is more common in women, as their urethra is shorter than men’s and closer to the anus. That makes transfer of bacteria to the urinary tract easier.
The infection can cause pain or burning while urinating, feeling of pressure or cramping in the lower abdomen or groin, the need to urinate even with an empty bladder, and frequent urination.
“In addition to the unpleasantness, the pain and the frequency of urination, infection can sometimes leave the bladder, which is where uncomplicated UTIs are, and creep up to the kidneys and then infect the kidneys themselves, which is a much more complicated infection. Beyond that, they can sometimes have these bacteria spread over into the bloodstream and cause sepsis,” Schaffner said.
Dr. Lee Riley is a professor of epidemiology and infectious disease at the University of California, Berkeley. He’s currently researching resistance and genetics of community-acquired UTIs.
“Even in our own environment here in Berkeley, we have seen a progressive increase in resistance over the last 17 years we’ve been doing this project on UTIs. It’s clearly becoming an issue,” he told Healthline.
Riley argues that many people underestimate the potential public health ramifications of being unable to successfully treat UTIs.
“We consider UTIs to be a gateway disease to all kinds of drug-resistant infections. UTI itself doesn’t kill people… But what happens with a UTI is it’s such a common disease, more antibiotics are used to treat the infection than any other infectious disease. So when you have such an overwhelming use of antibiotics, you’re bound to create drug-resistant strains. It’s a huge public health issue… We’re just waiting for all of these drug-resistant infections to happen,” he said.
Riley says in parts of the world such as India and Southeast Asia, UTI cases are so severe and so resistant to oral antibiotics that people have to be hospitalized to receive intravenous antibiotic treatment.
“I can easily see that happening in the U.S. Even in some pockets of the U.S. this is beginning to be seen. It’s still relatively low frequency, but we are beginning to see this,” Riley said.
“If this trend of antibiotic-prescribing practices and the use of antibiotics in animal husbandry continue, then we are going to see this kind of situation even in the U.S.,” he added.
Antibiotics are the first-line treatment for UTIs.
The type of antibiotic prescribed and its course duration varies depending on the type of infection.
According to the Mayo Clinic, common first-line antibiotic treatments include Bactrim and Septra.
But experts are warning that these common treatments are becoming ineffective.
“Although there is regional variability, in the United States more than 20 percent of E. coli, the most frequent cause of urinary tract infections, are resistant to some of the most commonly prescribed antibiotics, such as co-trimoxazole… Bactrim and Septra,” Dr. Stanley Deresinski, a clinical professor of medicine in the division of infectious diseases at Stanford University in California, told Healthline.
“The seemingly unrelenting growth of antibiotic resistance is a problem not just in the treatment of urinary tract infections, but in many other types of infection as well, including many that are potentially lethal if untreated,” he said. “The problem has grown to the extent that many have expressed the concern that we are headed toward a post-antibiotic apocalypse.”
Dr. Larissa May is a professor of emergency medicine at the University of California, Davis. In her career, she’s seen numerous antibiotics become ineffective against UTIs.
“TMP-SMX, fluoroquinolones, and cephalosporins are examples. One of the initial first-line treatments, amoxicillin, which was still an option when I was in medical school, is almost never used due to resistance,” she told Healthline.
“The pipeline of new antibiotics, particularly for the kind of bacteria causing UTI, is very slow,” she added. “This could mean even healthy patients would be at risk of severe illness and death from UTI if we don’t do something to curb this. Some of our last-resort options like colistin are also extremely toxic, and now resistance has been reported to them as well.”
Despite growing antibiotic resistance, experts still say the only treatment option available is antibiotics.
This week, the
Experts say the sooner a person can get to the doctor and start a course of antibiotics for UTI, the better.
“If the treatment is not initiated right away, they can then develop kidney infection, and if you get kidney infection and that’s not treated, that can convert into bloodstream infection. And then you have a really serious problem,” Riley said.
Some of the experts who spoke with Healthline say antibiotic-resistant UTIs could be just the beginning of a problem with potentially disastrous consequences.
Since antibiotics were first developed in the 1940s, experts have warned that improper use would lead to bacterial resistance.
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Schaffner recalls one former head of the Centers for Disease Control and Prevention saying antibiotic resistance is what keeps him up at night.
“That’s a sentiment that is shared by every single infectious disease specialist in this country,” he said.