Drug-re­sis­tant UTIS are harder to treat

The Saline Courier - - OPINION - Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and assistant pro­fes­sor of medicine at UCLA Health. D . R GLAZIER

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Dear Doc­tor: I had a uri­nary tract in­fec­tion that im­proved on the an­tibi­otic Ke­flex, but lab tests showed the bac­te­ria was ac­tu­ally re­sis­tant to the Ke­flex, so I had to switch to a dif­fer­ent an­tibi­otic. I don’t un­der­stand -- if the in­fec­tion was re­sis­tant, why did the symp­toms go away?

Dear Reader: Uri­nary tract in­fec­tions, or UTIS, are one of the most com­mon bac­te­rial in­fec­tions in the U.S. They oc­cur when bac­te­ria -- in the ma­jor­ity of cases it’s E. coli -- col­o­nize any of the tis­sues or struc­tures of the uri­nary sys­tem. This in­cludes the kid­neys, which fil­ter waste and ex­cess wa­ter from the blood to make urine; the ureters, which are the tubes through which urine leaves the kid­neys; the blad­der, where urine is stored; and the ure­thra, through which urine leaves the body.

Al­though both men and women can get a UTI, the con­di­tion is more com­mon in women. Ac­cord­ing to some es­ti­mates, any­where from 40% to 60% of women will have at least one UTI in their life­time. Symp­toms can in­clude urine that is dark, cloudy, bloody or pun­gent, an ur­gent need to uri­nate that yields very lit­tle urine, pain or burn­ing dur­ing uri­na­tion, and ab­dom­i­nal pain. In the el­derly, a UTI can present with­out any phys­i­cal symp­toms, but re­sult in con­fu­sion or tem­po­rary cog­ni­tive im­pair­ment.

Un­for­tu­nately, as you have ex­pe­ri­enced first­hand, uri­nary tract in­fec­tions are be­com­ing in­creas­ingly chal­leng­ing to treat. This is due to the grow­ing prob­lem of drug-re­sis­tant pathogens, which af­fect an es­ti­mated 2 mil­lion peo­ple in the United States every year.

An­tibi­otic re­sis­tance hap­pens when drugs are no longer ef­fec­tive at com­pletely erad­i­cat­ing the bac­te­ria and fungi that cause in­fec­tion and dis­ease.

That means that al­though some of the bac­te­ria or fungi may be killed by the drug, oth­ers aren’t. Those that are re­sis­tant to the drug will con­tinue to grow and re­pro­duce, caus­ing the dis­ease or con­di­tion to per­sist.

We sus­pect that in your case, the ini­tial an­tibi­otic killed enough of the bac­te­ria that were caus­ing your UTI for the symp­toms to abate and af­ford you phys­i­cal re­lief. How­ever, be­cause the in­fec­tion in­cluded bac­te­ria that were re­sis­tant to Ke­flex, the UTI was not be­ing cured. Those bac­te­ria that were re­sis­tant to Ke­flex were con­tin­u­ing to grow. For­tu­nately, your health care provider fol­lowed the cur­rent guide­lines to send a urine sam­ple out to test for an­tibi­otic re­sis­tance. Us­ing the re­sults of those lab tests, you were pre­scribed a dif­fer­ent and ideally more ef­fec­tive an­tibi­otic. In some cases, it can take mul­ti­ple at­tempts with dif­fer­ent an­tibi­otics to suc­cess­fully van­quish a UTI. Which­ever drug is pre­scribed, be sure to ask about po­ten­tial in­ter­ac­tions with food or other drugs, and to com­plete the reg­i­men, even af­ter symp­toms go away.

Be­cause of the risk of the in­fec­tion mov­ing to the kid­neys, it’s im­por­tant to make sure that a UTI is com­pletely cleared up. Pa­tients whose uri­nary tract in­fec­tion is caused by a drug-re­sis­tant strain of bac­te­ria should con­tinue to be fol­lowed af­ter an­tibi­otic ther­apy is com­plete. We rec­om­mend at least one re­peat urine test to “test for cure” and make sure that the UTI has been com­pletely erad­i­cated.

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