Nearly one in two women and one in twenty men will suffer a urinary tract infection (UTI) in their lifetime (Kidney Health Australia 2016). Antibiotics are the mainstay of treatment, however their frequent use has led to an increase in antibiotic-resistant organisms and bacteria, which are now gaining the upper hand.
Scientists are developing a novel new therapy to treat UTIs that does not include the use of traditional antibiotics.
Researchers (Jiang et al. 2012) have developed substances that target the bacteria’s ability to adhere to the bladder wall, rendering them unable to start an infection. Theoretically, this new class of antimicrobials should solve the problem of microbial resistance. The strongest of these substances has been shown to prevent UTI development in mice for up to eight hours. The effectiveness of this treatment was equal to that of Ciprofloxacin, a common potent antibiotic used to treat UTIs.
The emergence of ‘superbugs’ has concerned the science and medical community for the past several years. New and novel therapies may present our best hope of winning the war against lethal strains of bacteria that are immune to conventional antibiotics.
A urinary tract infection is the invasion of any structure of the urinary tract (ureters, urethra, bladder, or kidneys) by an organism capable of causing disease. Infection may be caused by viruses, bacteria, fungi or parasites. Specific terms are used to indicate which of the structures are involved (i.e. the term pyelonephritis is used to describe a kidney infection). Escherichia coli is the causative organism in approximately 80 to 90 per cent of infections (Jarvis et al. 2014).
Who Gets UTIs?
Anyone of any age can experience a UTI. Females tend to develop UTIs more readily due to their differing anatomy. The female urethra is much shorter than the male’s, making it easier for bacteria to gain entrance to the urinary tract. The shorter urethra of females also means that urine travels a shorter distance to exit the body, so fewer bacteria are expelled by the process of urination.
Although some UTIs are ‘silent‘ and do not cause symptoms, UTIs typically produce the following signs and symptoms:
- Urinary frequency
- Urinary urgency
- Dark or cloudy urine
- Foul-smelling urine
- Lower abdominal discomfort
- Vaginal discharge in women
- Rectal, testicular or penile pain in men
- Vomiting/diarrhoea, poor feeding (usually in infants and small children)
- Hypothermia (in older patients)
- Fever (upper urinary tract infection)
- Confusion, lethargy and weakness (older patients)
- Flank pain (kidney infection).
Risk Factors for UTI
Any condition that impedes bladder emptying or causes urine retention may increase the risk of UTI:
- Urethral strictures or other anomalies
- Kidney stones
- Prostate enlargement
- Sexual activity (the mechanical activity of sexual intercourse is thought to introduce bacteria to the urinary meatus, where it may gain entrance into the urinary tract)
- Neurological conditions that result in incomplete bladder emptying (diabetes, Multiple Sclerosis, paralysis)
- Individuals with compromised immune systems.
Diagnosis of UTI
Diagnosis can be made on the basis of symptoms and history. Urinalysis may reveal the presence of blood in the urine as well as nitrates and white blood cells. Urine is typically cultured. Most laboratories will report a positive culture as having >100,000 bacteria/cc of urine. Identification of the bacteria and sensitivity testing is also performed to identify which antibiotic the identified organism is sensitive to. The presence of fever and chills may point to infection of the kidney(s); a serious infection that can permanently damage the kidneys if not treated appropriately and completely.
Antibiotics are typically prescribed before the results of urine culture become available in 24 to 48 hours. Sometimes this practice means that the antibiotic must be changed when the results of the urine culture are available and indicate that another antibiotic is required to treat the infection, rather than the one that was prescribed.
A treatment that aims at preventing organisms from gaining a foothold in the first place is welcome news, as more and more bacteria are becoming resistant to the antibiotics that have been effective in the past.
- Jarvis, TR, Chan, L & Gottlieb, T 2014, ‘Assessment and Management of Lower Urinary Tract Infection in Adults’, Australian Prescriber, vol. 37, no. 1, viewed 26 October 2016, https://www.nps.org.au/australian-prescriber/articles/assessment-and-management-of-lower-urinary-tract-infection-in-adults
- Jiang, X, Abgottspon, D, Kleeb, S, Rabbani, S, Scharenberg, M, Wittwer, M, Haug, M, Schwardt, O & Beat, E 2012, ‘Antiadhesion Therapy for Urinary Tract Infections – A Balanced PK/PD Profile Proved to be Key for Success’, Journal of Medicinal Chemistry, vol. 55, no. 10, pp. 4700-13, viewed 26 October 2016, http://pubs.acs.org/doi/abs/10.1021/jm300192x
- Kidney Health Australia 2016, What is a Urinary Tract Infection?, UTI, viewed 26 October 2016, http://kidney.org.au/your-kidneys/detect/urinary-tract-infections/what-is-a-urinary-tract-infection