What you need to know about drug-resistant UTIs

About 60 percent of women and 12 percent of men will get at least one urinary tract infection (UTI) during their lifetimes, according to the Urology Care Foundation. These common infections, which occur when certain types of harmful bacteria creep into the urinary tract, are responsible for 8 to 10 million visits to healthcare providers (HCPs) in the United States each year.

For otherwise healthy people, a UTI can usually be wiped out with a three-day course of antibiotics. But an increasing number of these infections are becoming drug-resistant, meaning they can’t be cured with the usual antibiotics.

UTIs can trigger a range of uncomfortable symptoms, including pain or burning while urinating and cloudy, bloody, or smelly pee, as well as the frequent and often urgent need to urinate.

But even more concerning is that if left untreated, UTIs can move up from the urethra (the tube you use to urinate) and your bladder to your kidneys. That can lead to more serious complications, such as sepsis—a life-threatening response to infection.

What is the main cause of UTIs?

The bacterial species known as Escherichia coli (E. coli) causes 80 to 90 percent of UTIs, according to the National Kidney Foundation.

These bacteria normally live in your gut and most strains aren’t harmful. But if they stray outside the gastrointestinal (GI) tract, some types can cause infection. UTIs, for example, can result when bacteria from the bowel enter the urinary tract. And simple physiology helps explain why these infections more often affect people with female anatomy: They have a shorter urethra than do people with male anatomy, so bacteria from the anus don’t have far to travel to get to the urinary tract.

There is also some evidence that E. coli found in fresh poultry and meat products—including chicken, turkey, and pork—can cause UTIs in people. It’s unclear how the bacteria may spread to cause infection outside of the gut. Like other foodborne illnesses, eating undercooked poultry or improperly handling raw meat may be involved.

A growing threat

Risk factors for multidrug-resistant UTIs include recent hospitalization, being a nursing home resident, and recently having a urinary catheter. People who have previously taken antibiotics are also at higher risk.

In years past, drug-resistant UTIs were more likely to occur among hospitalized patients. Now, research shows that an increasing number of otherwise healthy people are developing these tough-to-treat infections.

Misuse of antibiotics

Before penicillin became widely available in the 1940s, more people died of bacterial infections than from non-contagious health issues, such as heart disease and cancer. Since then, the overuse or misuse of antibiotics (such as not taking them as prescribed, skipping doses, or not completing the entire course of treatment) has allowed some bacteria to adapt and develop resistance to existing drugs.

The rise in drug-resistant bacteria could increase the risk for complications associated with routine surgeries, injuries, and common infections, including UTIs.

Each year in the United States, some 2.8 million people develop infections caused by drug-resistant bacteria. These so-called superbugs now claim at least 35,000 lives annually, the Centers for Disease Control and Prevention reports.

Managing drug-resistant infections

A UTI that doesn’t clear up after a short course of antibiotics and some lifestyle adjustments may be treated with a longer course of drugs.

In more severe cases, antibiotics are given through an IV before transitioning to treatment with oral antibiotics.

When other treatments are limited or not an option, some people with drug-resistant UTIs may be candidates for newer therapies. One such therapy is Recarbrio, an antibacterial therapy comprising two existing drugs—imipenem and cilastatin—plus a newer drug called relebactam. The U.S. Food and Drug Administration approved Recarbrio in July 2019 for adults who have drug-resistant urinary tract infections or certain infections in the abdomen and have limited or no other treatment options. It’s also been approved for use in certain pneumonia cases.

Like all medications and other antibiotics, Recarbrio may cause unwanted side effects. The three-drug treatment may cause nausea, diarrhea, headache, fever, and increased liver enzymes, which may be a sign of inflammation or damage to the liver.

Despite this development, the fact is that bacteria will continue to adapt to the antibiotics that HCPs use to try to kill them. Meanwhile, these germs have been developing drug resistance more quickly than scientists have been able to develop new treatment options.

How to protect yourself

As the saying goes, the best medicine is prevention. You can help lower the risk of UTIs and recurrent infections by making some adjustments to your routine and personal hygiene habits. Consider doing the following:

• Urinate after having sex.
• Drink plenty of water to avoid dehydration.
• Urinate regularly and avoid holding in urine.
• Take showers instead of baths.
• Avoid douches as well as using sprays or powders around the genitals.
• Wipe front to back.
• If you are prone to UTIs and are using birth control, check in with your HCP. Spermicidal foam and diaphragms may increase the risk for these infections.

Vaginal estrogen may also help some women prevent recurrent urinary tract infections. Ask an HCP about whether it could be the right choice for you.