A digitally colorized scanning electron micrograph (SEM) of Escherichia coli bacteria, which often cause urinary tract infections.
Image: National Institute of Allergy and Infectious Diseases

The bacteria that cause urinary tract infections are not only becoming more resistant to antibiotics, suggests a recent study published in the Annals of Emergency Medicine, but they’re starting to spread outside of hospitals. Even worse than that, doctors might be losing their ability to predict when someone has a superbug, raising the chances of treating them with useless drugs that will further promote resistance.

The researchers behind this current study looked at the anonymized medical records of patients who visited the emergency room of a large urban hospital in Northern California. From August 2016 to July 2017, there were more than a thousand patients whose urine tested positive for a urinary tract infection. Most UTIs are caused by a family of bacteria called Enterobacteriaceae, featuring familiar bacteria such as Escherichia coli. And of the patients in the sample, around 6 percent had strains of Enterobacteriaceae resistant to broad-spectrum antibiotics such as penicillin, which are often used as front-line drugs against a wide variety of infections.

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That might not seem like a huge number in isolation, but it’s another sign of increasing antibiotic resistance, according to the authors. Other research has found that the incidence of these bacteria is steadily rising in the United States. The current study, however, provides a few additional nuggets of worry.

“What’s new is that in many of these resistant urinary tract infections, it may simply be impossible to identify which patients are at risk,” lead author Bradley Frazee, a critical care specialist at Highland Hospital in Oakland, said in a statement.

Ordinarily, hospitals are considered one of the major hotspots of antibiotic resistance, with many, if not most, superbug strains originating from and spreading through a health care setting. But 44 percent of the resistant cases the team found seemed to have been caught from somewhere else, out in the community. The percentage of resistant community-associated UTIs found in their sample, according to the authors, is the largest proportion ever reported in a U.S. study of this kind.

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These patients in particular were more likely to first be given routinely recommended antibiotics that often didn’t work against their UTI. That failure not only wastes time and resources, as doctors scramble to find the right combination of drugs that do work, but also fosters more antibiotic resistance.

Because they only looked at patients from one hospital, there needs to be more research done to figure out whether these community superbugs are really becoming more common. But Franzee and his team are already pushing for widespread changes in how emergency room doctors treat UTIs. These include testing the urine of anyone suspected of having a UTI, no matter how mild their case; having up-to-date information on known resistant strains circulating in the area; and overall relying more on antibiotics not commonly resisted by these bacteria for the initial treatment.

Of course, even these suggestions are more of a stopgap solution than anything else. And the long-term prognosis, if nothing else changes, is pretty bleak. It’s estimated that antibiotic-resistant infections already kill 300,000 people worldwide annually, including 23,000 in the U.S., and might kill as many as 10 million people a year by 2050.

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“Addressing the causes of antibiotic resistance, and developing novel drugs, is imperative,” said Frazee. “A society without working antibiotics would be like returning to preindustrial times, when a small injury or infection could easily become life-threatening.”


[Annals of Emergency Medicine]