For kids, women, and seniors, the three letters U, T, and I long described an uncomfortable, inconvenient, and embarrassing condition. The time, though, may have past for the swift and easy relief that diagnoses of urinary tract infections once might have brought. Instead, doctors are expressing concern that the bugs that cause all-too-common UTIs are becoming different and antibiotic resistant.
As the New York Times reported, the shifts already are meaning “more hospitalizations, graver illnesses and prolonged discomfort from the excruciating burning sensation that the infection brings.” The newspaper added:
“The New York City Department of Health has become so concerned about drug-resistant UTIs … that it introduced a new mobile phone app this month that gives doctors and nurses access to a list of strains of urinary tract infections and which drugs they are resistant to. The department’s research found that a third of uncomplicated urinary tract infections caused by E. coli — the most common type now — were resistant to Bactrim, one of the most widely used drugs, and at least one fifth of them were resistant to five other common treatments.”
Researchers are tracing the rise of E. coli related UTIs to foodstuffs, especially infected poultry. The bacteria may not sicken people when they eat. But the E. coli gets moved into the gut, where it flourishes and may be spread by fecal residue to the urethra — an issue especially for women due to anatomy.
Growing antibiotic resistance by E. coli may be unsurprising, as the New York Times reported:
“Resistance to antibiotics has become one of the world’s most pressing health issues. Overuse of the drugs in humans and livestock has caused germs to develop defenses to survive, rendering a growing number of medicines ineffective in treating a wide range of illnesses — a phenomenon that is playing out worldwide with UTIs. The World Health Organization, while noting that data on urinary tract infections and drug resistance is ‘scarce,’ said the fact the infections were so common strongly suggested that increasing resistance would lead to more severe illnesses and fatalities.”
Not only are UTI-causing germs showing increasing resistance to “gold standard” individual antibiotics, they also aren’t as susceptible to drug combinations. This means doctors and hospitals must turn to different drugs and may need to dose with them longer. This can undercut the alternatives’ effectiveness over time, adding to the mess of antibiotic resistance.
It is a significant health concern, the independent, nonprofit RAND Corp. has found. Researchers there estimated in a published study that, without action to avert a crisis, the “true cost of antimicrobial resistance will be 300 million premature deaths and up to $100 trillion lost to the global economy by 2050.”
The New York Times reported that patients are experiencing longer, more inconvenient treatment for UTIs and complications that can be even more threatening, costly, and difficult. The infections themselves may be becoming more common and experts are urging study of this issue. But UTIs always have been a greater bane for women, though they pose significant problems, too, to frail seniors, as the newspaper reported:
“What makes these infections so dangerous, and commonplace, is human anatomy. In women, the urethra — the gateway to the urinary tract — is in proximity to the rectum. This can lead to easy transfer of bacteria in fecal residue that otherwise resides harmlessly in the gut. In reproductive years, women are 50 times more likely than men to have a urinary tract infection; later in life, the ratio drops to 2 to 1, as men wind up having surgical procedures on their prostate, or catheters, that more easily expose their urinary tracts to infection.”
Here’s some of what the federal Centers for Disease Control and Prevention has to say about UTIs and their symptoms, which include:
- Pain or burning while urinating
- Frequent urination
- Feeling the need to urinate despite having an empty bladder
- Low fever (less than 101 °F)
- Cloudy or bloody urine
- Pressure or cramping in the groin or lower abdomen
Because UTIs may have different microbial causes and may require differentiated treatment, as a result, experts say that patients options are narrowing: If they think they’ve got a UTI, they should see their doctor and they may need to undergo more testing than before.
The agency also advises that “changing personal hygiene habits can help prevent recurrent UTIs,” including by: Urinating before and after sexual activity; staying well-hydrated and urinating regularly; taking showers instead of baths; minimizing douching, and sprays or powders in the genital area; and when potty training girls, teaching them to wipe front to back.
In my practice, I see the harms that patients suffer while seeking medical services, and experience underscores the value in their staying as far as they can away from health care systems to avoid the damages they can inflict. Patients may be exposed to significant injury when treated at hospitals, even the best, most caring, and careful institutions with major reputations.
Although the fatalities have declined, preventable hospital deaths kill more than 160,000 Americans annually — four times as many lives as were lost to vehicle wrecks in 2017, more than twice the deaths attributable to opioids and drug overdoses that year, and more than the toll of stroke or Alzheimer’s disease. That disturbing information comes from Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality and the Leapfrog Group, a national nonprofit founded by large employers and others concerned and focused on safety and quality in health care.
Hospital deaths, by the way, are a slice of the 250,000 lives lost each year due to medical error. Medical errors claim the lives of roughly 685 Americans per day — more people than die of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It means medical errors rank as the third leading cause of death in the U.S., behind only heart disease and cancer.
Hospitals keep insisting they’re doing all they can to attack infections their already ill or injured patients acquire while in their care. But more needs to be done, as Leapfrog has reported. The group has found that “one out of 25 patients in U.S. hospitals contracts [a health care acquired infection or HAI]. These infections can significantly delay recovery, increase the expense of a hospital stay, and even result in death. Of the approximately two million American patients who acquire an HAI annually, an estimated 90,000 will die … The cost of a single case can range from just under $1,000 to nearly $50,004, depending upon the type of infection — with the direct cost of HAIs to hospitals estimated at between $28 billion and $45 billion. These costs are passed along to insurers and employers, as well as to patients themselves in the form of higher out-of-pocket costs.”
We’ve got a lot of work to do — to reduce UTIs, to slash antibiotic overuse and abuse, and to continue to improve food safety.