What Multidrug-Resistant UTIs Mean for Chronic Sufferers

4 min read

drug-resistant UTIs

UTIs are the second-most common infection in the human body, and 50-60% of women will get one at some point in life. For most, it’s an awful but rare experience, brought on by sex or another obvious trigger. But for some women, UTIs become an ongoing battle. And with antibiotic-resistant infections on the rise, it’s only getting harder to fight.

Chronic UTI sufferers face a tough dilemma

Chronic UTIs are common, with around 27% of women facing a recurrence within 6 months after their first UTI, usually from the same bacteria that caused the initial infection. From there, the infections can become more frequent and harder to treat. The cycle is enough to upturn life. On top of the pain and frustration, each UTI means added medical costs, missed work, and impacted relationships.

For Casey Shull, UTIs became a regular part of life as soon as she hit puberty. By her late 20s, she was getting them every 2 weeks. “Things became unbearable,” Shull wrote in a recent blog. “The crippling pain, the feeling of hopelessness. The medical staff got to know me so well I would walk in and the receptionist would say, ‘Again?’ as she checked me in.”

Shull was prescribed prophylactic antibiotics — a low dose taken after sex to prevent infections. It worked for a while, but she eventually developed a resistance to the drugs. The next option? Start a new drug, and potentially face the same issue in a couple years or less.

“I was uncomfortable with the idea,” Shull wrote. “What happens if I become resistant to all the common antibiotics to treat UTIs? What then? And how could I keep my gut healthy when I’m constantly popping pills?”

UTIs are “the single biggest risk to healthy people from drug-resistant germs”

Shull’s dilemma is one faced by millions of people each year. While UTIs were once simple to treat, that’s changed. Today, drug-resistant infections are on the rise because of the wide misuse of antibiotics in people and animals. As frontline treatments fail and multidrug-resistant superbugs spread, nations are scrambling to find solutions.

The World Health Organization (WHO) calls antibiotic resistance “one of the biggest threats to global health, food security, and development today.” And UTIs are particularly threatening because such a large portion of the population is at risk. In a chilling article last month, The New York Times reported that one third of uncomplicated UTIs are now resistant to Bactrim, one of the most commonly prescribed drugs, and at least one fifth are resistant to 5 other common drugs.

“Usually, it is people with weakened immune systems or chronic medical conditions who are most vulnerable to drug-resistant infections, but U.T.I.s have a dubious distinction: They are the single biggest risk to healthy people from drug-resistant germs.” - The New York Times

In an effort to keep the problem under control, WHO has called on health providers to limit prescription of antibiotics to when they are needed, according to current medical guidelines. That means first running lab tests to reach a diagnosis and, in the event of an infection, identify the specific bacterial strain at hand.

But in practice, it’s more complicated. When patients present with intense pain and all the symptoms of a UTI, doctors feel pressured to make quick decisions. Lab results can take days, and they’re often costly for patients, so urine cultures are often skipped altogether. A U.K. study found that 86% of patients diagnosed with a UTI received antibiotics that same day — and 83% of those patients didn't report having a urine test performed. Faced with the decision of waiting or treating, most doctors will write the prescription.

Getting to the core of recurrent UTIs

With fewer treatment options at hand, more and more women are desperate for solutions to get ahead of their UTIs — and sick of hearing the same basic prevention tips. While peeing after sex, practicing good hygiene, and wearing cotton underwear will work for most people, it’s not enough for chronic sufferers, who are typically more susceptible to UTIs thanks to health conditions, hormonal changes, or an array of other factors.

So what else can you do?

Though cranberry supplements have long been touted as an effective option, the data is inconsistent. And while D. mannose has shown success in preventing UTIs, it’s rarely enough to put a stop to more serious, recurrent infections. Instead of focusing on one magic bullet, it’s important for chronic sufferers to take a multifaceted approach that addresses the root problem: biofilm and dysbiosis.

Recurrent UTIs are typically caused by bacterial “biofilm” — a protective layer that can shield bacteria from antibiotics and the immune system. If bacteria survive a course of antibiotics, they can use biofilm to hide out in the urinary tract and multiply, creating large populations of drug-resistant bacteria. When these bacteria release into the urinary tract, it can trigger a new infection that seems to come out of nowhere.

This is the core issue faced by chronic sufferers. UTI-causing bacteria are constantly finding new ways to evade treatment. And simultaneously, antibiotics are killing off the “good” bacteria that protect from UTIs, creating a state of dysbiosis that leaves women open to new infections and a host of other problems, like bacterial vaginosis and yeast infections.

Aggressive prevention is the only path forward

The key to breaking the treat-and-repeat cycle is to take a three-pronged approach:

  1. Prevent new bacteria from taking hold.
  2. Wipe out the biofilm that causes repeat infections
  3. Repopulate the body with protective bacteria. 

Most standard prevention methods only address the first option, focusing on clearing out new bacteria after sex, exercise, or other common triggers. While that is a key piece of the equation, it's not enough. Overcoming chronic UTIs requires a coordinated approach. When healthy microbial diversity is restored and the build-up of old bacteria is eliminated, it's much easier to prevent future infections.

Though the headlines are scary, they're drawing attention to an issue that hasn't gotten nearly enough attention. UTIs impact women at 50x the rate of men. Half the world's population is liable to get one at some point. It's important that we continue to push the conversation forward and give people the resources they need to safeguard their health.

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