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For generations, urinary tract infections, one of the most common ailments in the world, have been easily and quickly cured with simple antibiotic therapy.
But it is becoming increasingly clear that infections, which affect millions of Americans every year, mostly women, are becoming more resistant to these drugs, turning a single routine diagnosis into more hospitalizations. , more serious illnesses and prolonged discomfort resulting from the atrocious burning sensation that the infection brings.
The New York City Department of Health has become so concerned about the popularity of drug-resistant anti-tetanus drugs, as they are widely known, that it has launched a new mobile phone application this month. doctors and nurses thus have access to a list of strains of urinary tract infections and the drugs they resist.
The department's research found that one-third of uncomplicated urinary tract infections caused by E. coli – the most common type at the present time – were resistant to Bactrim, one of the drugs most used, and that at least one-fifth of them were resistant to five other common diseases. treatments.
"It's crazy, it's shocking," said Lance Price, director of the Center for Action Against Antibiotic Resistance. at George Washington University, who was not involved in the research. The drug ampicillin, once a mainstay in the treatment of infections, has been abandoned as a reference standard because it is so often resistant to multiple strains of U.T.I.s. Some urinary tract infections now require intensive intravenous antibiotic therapy. Last year's researchers reported in a to study that one-third of all Americans in Britain are resistant to "essential antibiotics".
Definitely, the daily experience of having a U.T.I. grows less routine for many women.
Carolina Barcelos, 38, a postdoctoral researcher in Berkeley, Calif., Said she had several teenagers in her teenage years, all successfully treated by Bactrim. When she had one in February, her doctor also prescribed Bactrim, but this time it did not work.
Four days later, she came back and received a new prescription for a drug called nitrofurantoin. It did not work either. His pain worsened and several days later, there was blood in his urine.
His doctor prescribed a third drug, ciproflaxacin, the last of the three main-line drugs, and grew his urine. The culture showed that his infection was sensitive to the new drug, but not to the other two.
"Next time," said Dr. Barcelos, "I'm going to ask them to culture right away, and for eight days I was taking antibiotics that were not working for me."
It is usually people with weakened immune systems or chronic diseases who are most vulnerable to drug-resistant infections, but the United States has a dubious distinction: drug-resistant germs are the main risk for people in good health.
Antibiotic resistance has become one of the most pressing health problems in the world. Overuse of drugs in humans and livestock causes germs to develop defenses to survive, making an increasing number of drugs ineffective at treating a wide range of diseases – a phenomenon that is rife around the world in the United States.
The World Health Organization, while noting that data on urinary tract infections and drug resistance are "rare", stated that the fact that infections were so common was likely to suggest that increased resistance would lead to more serious illnesses and deaths.
According to researchers and clinicians, the solution is to lobby for more judicious use of antibiotics around the world. But more immediately, a partial solution would be to develop quick and inexpensive diagnostic tools that would allow instant urine culture so that the doctor can prescribe the right medicine for U.T.I.s.
But if you have to wait several days before getting the lab results before you prescribe, it's a difficult dilemma for doctors and patients, who often desperately seek relief. In addition, depending on a person's insurance, acquiring a crop can be expensive.
As a rule, doctors still do not prescribe urine culture before prescribing an antibiotic.
"Previously, the list of antibiotic options was short, but by and large, they would all work," said Dr. James Johnson, Professor of Infectious Diseases and lead researcher on urinary tract infections at the University of Minnesota.
Some women have U.I.I. that the body does it all by itself without using antibiotics, while others may have a different low-level disease that looks like a U.T.I., but this is not the case. The safest solution is to consult a doctor and make an informed decision that includes a judicious determination of the appropriateness of taking antibiotics. Science does not support the effectiveness of some folk remedies like cranberry juice or cranberry pills.
Officials at the Federal Centers for Disease Control and Prevention said that people with U.S..S. acquired by otherwise healthy people were a growing concern and that they were poorly studied. They are not the subject of a national follow-up.
In the elderly, urinary tract infections can be fatal, but in the US, the follow-up is so low that there is no reliable estimate of the number of deaths related to these infections. C.D.C. published an estimate of 13,000 per year, but this figure comes from an article that examines the 2002 data and mentions only the United States acquired in hospitals.
Dr. Clifford McDonald, Deputy Director of Science in the Division of Health Quality Promotion in C.C., said the government planned to expand its research.
"If we do not do something soon," says Dr. McDonald, "this will push all of our treatments to more advanced antibiotics that are finally putting a lot of pressure on the last-line treatments."
What makes these infections so dangerous and mundane is the human anatomy. In women, the urethra – the gateway to the urinary tract – is near the rectum. This can facilitate the transfer of bacteria into the faeces residues that otherwise are in the gut.
In women of childbearing age, women are 50 times more likely than men to have a urinary tract infection; later in life, the ratio drops to 2 to 1 because men end up undergoing surgeries on their prostate, or catheters, which more easily expose their urinary tract to infection.
There are many germs responsible for U.T.I.s, and their level of drug resistance varies among strains and strains. where a patient lives. E. coli is by far the most common cause of American tuberculosis. In general, these infections have been significant increase in resistance to standard treatments over the past 15 years.
New research shows that food, usually poultry, is a crucial pathway for the transfer of germs that cause U.T.I. Poultry consumed is found in the intestines of a person and can be transferred into the urethra by faecal residues.
A study published last year by the American Society of Microbiology, funded in part by the C.D.C., revealed the presence of 12 strains of E. coli. Coli in poultry corresponding to strains of urinary tract infection with significant circulation. One of the authors of the study, Dr. Lee Riley, a professor of epidemiology and infectious diseases at the University of California at Berkeley said that he was working on a project funded by BC. to determine whether the urinary tract infection should be classified and reported as a foodborne illness.
Dr. Brad Frazee, an emergency physician at Highland Hospital in Oakland, California, was co-author of research that adds another disturbing wrinkle: E. coli is proving increasingly resistant to individual antibiotics, but also to a broad group of drugs called beta-lactam antibiotics. These medications share a way to fight the infection, and when a germ develops resistance to this method of attack, it simultaneously eliminates several key treatment options.
Recently, a woman with such resistance arrived at Dr. Frazee's hospital, he said. She was found with pyelonephritis, kidney infection and had to be treated in the hospital intravenously with a drug called ertapenem. it can cost $ 1,000 per dose. One study found that about 5% of American patients at the hospital exhibited this resistance.
Doctors are currently facing cases of resistant urinary tract infections. Dr. Eva Raphael, A San Francisco primary care physician was recently notified that one of his patients, a healthy woman in her 30s, was back in the ER with another American patient. which was resistant to several antibiotics.
One of his previous patients in the United States had not responded to two commonly used treatments and had spread to the kidney, requiring hospitalization to receive intravenous antibiotics. This time Dr. Raphael consulted with infectious disease specialists.
"It can be quite dangerous in this age when there is more and more resistance," she said, noting that without effective treatment, the infection can enter the bloodstream. "It can be fatal."
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