Urinary Tract Infections
By Allan R. Handysides and Peter N. Landless
The doctor tells me that I had an antibiotic-resistant urinary tract infection. I had to take an expensive antibiotic by intravenous infusion. I was very ill. Can you tell me more? I’m nervous now, and I want to do all I can to prevent a recurrence. I’m a 45-year-old woman, married, and the mother of two children, ages 14 and 16.
Urinary tract infections (UTIs) are quite common in women. In fact, every year 12 out of 100 women ages 20 to 24 come down with an infection. More than 40 percent of women experience one UTI in their lifetime, and some 25 to 33 percent experience more than a single infection.
The most common germ causing this infection is called Escherichia coli (E. coli); during the past few years an increasing number of these germs have become resistant to multiple antibiotics. These organisms are resistant to antibiotics because they produce an enzyme that destroys the “beta-lactam” antibiotics. They have been called extended-spectrum beta-lactamase-producing organisms, or ESBL for short.
E. coli that have a special ability to cause UTIs do so by attaching themselves to glycoproteins in the wall of the bladder. These E. coli are specifically dangerous to the urinary tract because they possess small fimbriae (fingers) that stick them onto the cells of the bladder, which keeps them from being easily washed off. Some of these E. coli also secrete toxins that damage the bladder lining and promote infection.
The bladder, in its defense, produces substances that give some resistance to the infection, and the kidneys also produce proteins that coat the fimbriae on the E. coli. UTIs represent a failure of these defense mechanisms.
As women grow older and become postmenopausal they are at an increased risk of UTIs, because the vaginal bacteria that keep the vagina acidic and slow the growth of E. coli there, called friendly lactobacilli, decrease in number. Similarly, antibiotic use also may decrease the number of these lactobacilli. The female anatomy makes it easier for colonic bacteria (E. coli) to get into the bladder. A variety of recommended methods—such as the direction of wiping and the use of douches—have not been shown to reduce the risk of urinary tract infections.
Prevention, which is our emphasis in this column, would suggest that drinking copious amounts of water—enough to ensure clear-colored urine—might be helpful to women with a urinary infection. This makes for natural and frequent flushing of the bladder. Naturally, any anatomical abnormality that can be corrected should be treated. Cranberry juice, if available in the region of the world in which you live, makes the urine acidic and possibly blocks the adherence of the bacteria to the bladder wall. Lactobacilli to populate the vagina have been administered as a probiotic in capsule form, but evidence of the efficacy of such measures in reducing the incidence of UTIs is lacking.
In the postmenopausal woman, topical vaginal estrogen cream may help reestablish the vaginal cells and lactobacilli, in turn creating a more acidic environment that inhibits E. coli. Studies are not uniformly supportive of such treatment, however. Despite the increase in highly resistant forms of E. coli, there still are a few strategies to combat urinary tract infections. A form of antibiotics called carbapenems have to be given by intravenous route, but are capable of eradicating ESBLs.
Urine cultures will often show sensitivity to cheaper, more common antimicrobials, and these should be used for symptomatic UTIs. An antibacterial medication called fosfomycin has been used in Europe and Japan, and so far seems to be a satisfactory medication when given as a single three-gram dose. It cannot cure kidney infections and sepsis, however, and is not indicated for these serious infections. In the laboratory clavulanic acid seems to be effective against ESBL-producing E. coli, but in practice it has not been as successful.
Research continues with various combinations of antibiotics. In the meantime, drinking lots of water and other fluids, impeccable personal hygiene, and possibly the use of local estrogens if postmenopausal, are a woman’s best hope of staying clear of UTIs.
Allan R. Handysides, a board-certified gynecologist, is director of theGeneral Conference Health Ministries Department.
Peter N. Landless, a board-certified nuclear cardiologist, is associate director of the General Conference Health Ministries Department.