WHAT DOES THAT MEAN FOR YOU?
One of the few good things about urinary tract infections is that, without any complications, they’re easy to treat: You describe your symptoms to a doctor, probably pee in a cup for an analysis, get an oral antibiotic based on your symptoms that has few (if any) side effects, and start feeling better within a day or so.
But, for lots of women all over the world, that simple, straightforward treatment is becoming increasingly rare. As terrifying headlines warn, UTIs are becoming more difficult to treat as the bacteria that cause them “learn” to survive almost all of the oral antibiotics we currently have. Antibiotic resistance in general has been a problem for as long as antibiotics have existed and is considered an urgent threat to public health; in the fight to slow it down, one of the primary infections global health officials are focusing on is the UTI.
According to Dr. Carmem Pessoa, a medical officer and expert on antimicrobial resistance at the World Health Organization, the latest WHO surveillance report on global antibiotic resistance found high rates — above 25-50 percent — of resistance to the oral antibiotics most commonly used to treat UTIs. Researchers are particularly focused on E. coli bacteria (the cause of most UTI infections) because E. coli resistance to the antibiotics most widely used to treat UTIs“may be indicative of resistance to one of the last available oral treatment options, particularly in low-resource settings.”
When oral antibiotics fail, physicians have to turn to last-resort antibiotics like colistin that are given through an IV and come with severe side effects like kidney failure and seizure. And now there’s concern that bacteria is becoming resistant to even those options: Colistin-resistant infections have already been reported in various parts of the world, after researchers first found resistant bacteria on farm animals in China.
Drug resistance is natural. Dr. Rupa Kanapathipillai, an infectious diseases advisor at Doctors Without Borders, says it’s just in bacteria’s nature to mutate to survive the drugs we make to kill them. “Bacteria are designed to evolve to survive,” she says. “This is normal. Whatever you throw at them, bacteria are very clever and they will evolve to try to evade it.”
What isn’t normal is that, in trying to fix the problem, humans are making it worse. A 2016 report published by the British government revealed that overuse of antibiotics, unregulated use of over-the-counter antibiotics, use of strong antibiotics in agriculture (as is the case in China), and spill-off from medical waste are human-caused reasons resistance is increasing.
The combination of bacteria’s ability to easily evolve and its overexposure antibiotics is what makes UTIs such a looming threat. A non-complicated UTI won’t kill you. But a resistant infection that spreads to other parts of the body — like the kidneys or bloodstream — can.
Because of the way bacteria is spread, resistance patterns vary by region and are more severe in some places than in others. Kanapathipillai says there’s very little good quality data in most of the places where Doctors Without Borders operates, so tracking antibiotic resistance rates is difficult. But news reports from India in 2017 mention that overuse of antibiotics in the country has led to about half of all diagnosed UTIs requiring last-resort IV antibiotics like colistin and carbapenems.
“We are forced to use old injectable antibiotics with known toxicity to kidneys to save patients with multi-drug resistant UTI,” Dr. Anup Kumar, professor and head of the urology department at Safdarjung hospital in New Delhi, told Times of India in January 2017. “People may die of UTI.”
Resistance to a first-choice UTI antibiotic was found to be so high in the United Kingdom in 2014 that the country’s public health institute officially recommended switching to a different one. A 2017 study from a single hospital in northern Iran found nearly 88 percent of diagnosed UTIs over a two-year period were resistant to at least one antibiotic — a slight increase from previous years.
And according to a website that collects and maps data provided by global antibiotic resistance reports, resistance to carbapenums — another last-resort antibiotic for E. coli infections like UTIs — has already been reported in India and the United States.
The World Health Assembly released an action plan for all WHO Member Statesto address and fight resistance three years ago, Kanapathipillai explains. She says it’s not rocket science, but is a multidisciplinary approach meant to address the various ways resistance is accelerated by things like overuse of antibiotics and poor data availability.
“This is supposed to be a world-wide commitment,” Kanapathipillai says. “The reality is that very few countries have since completed their action plan.“
Even as the FDA approves new combinations of antibiotics designed specifically for treating these increasingly resistant infections, Mayora Walters, an epidemiologist and the lead of the antimicrobial resistance team with the Centers for Disease Control, says bacteria are mutating faster than we can make drugs to kill them.
“Our ability to create new antibiotics is being outpaced by the ability of bacteria to develop resistance,” she says. “And we’re seeing bacteria that are resistant to all antibiotics, except for drugs that have either a lot of bad side effects or are often associated with treatment failure. That’s a big concern.”
Walters says the best thing you can do to help fight the spread of resistance is to prevent infections that require antibiotics — so simple things like washing your hands, wiping from front to back, and peeing after sex to try and limit UTIs. And when you do get an infection requiring antibiotics, follow all of your doctor’s instructions and dispose of any unused antibiotics properly. She says you should also always tell your doctor if you’ve recently been out of the country so they can give antibiotics based on resistance patterns where you live and where you’ve traveled.
“If we aren’t really aggressive with preventing the spread of resistance, we will see this really high level of resistance not just in our healthcare facilities, but in communities,” Walters says. “What used to be relatively uncomplicated infections like UTIs will be very difficult, or impossible, to treat.”