New research may change treatment of UTIs

Evelyn Lewin

14/08/2019 3:34:39 PM

Recurrent UTIs may occur because of intestinal reservoirs of bacteria, rather than bladder sources.

Researchers in laboratory
Researcher Professor Mark Schembri (left) believes treatment for recurrent UTIs may need to eliminate infection in the intestine, rather than just the bladder.

Approximately 25% of women who experience a urinary-tract infection (UTI) will experience another infection within 12 months.
A new study may offer fresh hope for women who experience recurrent or chronic UTIs.
The research found that, instead of recurrent UTIs originating from bacteria in the bladder, the intestine may carry a reservoir of such bacteria.
The study followed a woman who has lived with recurrent UTIs for 45 years. During that time, the longest period the woman can recall being UTI-free is nine months.
Researcher Professor Mark Schembri told newsGP the study followed the woman closely for five years and discovered that all of her UTIs were caused by the same type of E.coli. They then collected and sequenced DNA of E.coli from the patient’s faecal samples.
‘When we looked to see why the UTI kept appearing despite the fact she had antibiotic treatment, we found that this same type of E.coli was in her intestinal microflora,’ Professor Schembri said.
‘What that means is that the intestine was serving as a reservoir of her infection.’
It also means the intestinal E.coli were not killed by the antibiotics she was receiving.
‘What we think is that, when we treat a UTI in such a patient who has chronic recurrent infection, if we don’t just worry about treating the infection in the bladder but we eradicated that bacteria from the intestine, then we would stop the recurrence of infection,’ Professor Schembri said.
While this study only followed one patient, Professor Schembri believes it is ‘absolutely’ possible that other women who experience recurrent or chronic UTIs may also have intestinal reservoirs of bacteria.
‘That’s something that we’d like to investigate further, because if we found that women with chronic UTIs did have this intestinal reservoir of bacteria, then it gives us another alternative for the way we treat and manage these infections,’ he said.
And treating such infections could lead to drastic changes in patients’ lives.
‘There’s a lot of women who are suffering from chronic recurrent UTIs and really this is a debilitating disease with no effective cure,’ Professor Schembri said.
‘It’s a bit of a silent epidemic.’
If people experiencing recurrent UTI are found to have intestinal reservoirs of bacteria, Professor Schembri believes treatment for these infections would be a combination of different antibiotics.
‘That kind of combination antibiotic [treatment] would be very novel to treat a chronic UTI,’ he said.
According to Professor Schembri, the antibiotics currently used to treat UTIs aim to achieve a very high concentration in the bladder or urine.
‘But if we want to achieve a high concentration of antibiotics in the intestine, then we may consider using a different type of antibiotic,’ he said.
At this stage, Professor Schembri cannot recommend which antibiotics may work best, as researchers have yet to identify where in the intestine the bacteria reside.
Dr Wendy Burton is a GP with a special interest in women’s health. She told newsGP there is a ‘big gap’ between these new findings and applying them to practical changes in general practice.
‘But [it’s] good to have direction,’ she said.

Dr Burton believes that, if this research leads to changes in treating recurrent UTI, it could be a ‘game-changer’.

Dr Burton said the challenge will be finding antibiotics that have good concentration in the bowel and bladder, ‘without nuking the gut flora, resulting in diarrhoea, thrush and the like’.
She believes important considerations regarding adapting this research into a general practice environment include the feasibility of testing bacteria for genomic sequencing outside of the research environment, along with cost considerations.
‘Very few general practice patients would reach the threshold for this type of testing, I suspect. But for those who do, it could be a game-changer if we can overcome the above issues,’ Dr Burton said.
Professor Schembri believes more funding is needed to provide further research into this area. In the meantime, he hopes doctors will look deeper into patients with recurrent UTIs.
‘GPs might consider in the management of patients who have chronic UTI, they may think a little bit more about just eradicating the bacteria from the bladder,’ he said.
‘They can start to think, “Well, where are the bacteria coming from? And are we seeing the same bacteria causing infection over a period of time?”
‘And, if so, they may take the step to invite the patient to seek help from a specialist who may be able to explore this further and determine whether it really is the same bacteria causing recurrent infection.’
While Professor Schembri acknowledged that the genetic analysis used is not available to GPs, he hopes the research will lead to further studies that can lead to treatment for recurrent UTIs.
‘I think we offer an alternative – that if we do sequence the bacteria that are present in the intestine and we do determine there is a reservoir of bacteria in the intestine, then we can come up with alternative ways to treat the infection,’ he said.

bladder infection urinary tract infection UTI

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Dr Peter J Strickland   15/08/2019 10:47:17 AM

This relationship between bowel and bladder organisms such as E Coli has been known for longer than 40 years. This whole contamination from the bowel to the bladder (and possible retro-flow to kidneys via reflux) may just simply be the way women clean their genitals post-urination/post-defaecation ---- that is what I would be looking at with respect to research here, and again using a genital decontamination wipe to prevent ureter entry of these E Coli. Using bowel antibiotics does not seem a good idea at all.

Dr Jesse Josef De Vries   15/08/2019 5:11:18 PM

I don't get it.
Lets wipe out the "reservoir" of S. aureus growing on the skin while we're at it so we wont get any more MRSA skin infections either.
There's no way this can be useful, surely?

Duncan Mackinnon FAMILY TS   15/08/2019 8:43:06 PM

I have a couple of patients in this category. One has a highly resistant e-Coli with several episodes of septicaemia but luckily several of her recent UTIs have not been resistant. We have considered faecal transplant and Dukoral although the data for its efficacy in e-Coli is questionable. The two ID physicians haven't had anything to add other than the usual prevention strategies. Does anyone have any advice?

Mark Karaczun   16/08/2019 5:34:30 AM

Sorry, but the hypothesis that UTI bacteria originate from gastro-intestinal tract is hardly news, is it? If not from the GIT, then where, exactly, would UTIs come from? The suggestion that we ramp up antibiotics to eradicate GIT bacteria strikes me as radically dangerous for the complex ecosystem that is our gut. Given the increasing evidence we have for the benefits of diverse microbiota, surely, perhaps we should be avoiding repeated or stronger antibiotics and be encouraging more growth of healthy bacteria that can perhaps out-compete pathogenic ones?

Lahna Young   16/08/2019 10:41:45 PM

Dear Doctor Strickland, Saying UTIs are probably caused by "the way women clean their genitals" is so rude and victim-blaming. I get recurrent UTIs and believe me, it's not from bad wiping! After I defecate I take a SHOWER! After I pee I use an antibacterial wipe. Before and after sex I clean myself. Still, I get UTIs. How did I manage to live 50+ years before this started happening (camping, playing in the dirt, living in farm country, having sex, etc)?

Dr.Dominic Karunanayake   20/08/2019 6:32:01 PM

I believe Identifying it is the same E-Coli coming from your gut would be only a small step to identifying the cause for recurrent UTI's. What's next ? Is it Retrograde flow along urinary tracts ? Therefore causes ?
Then other anatomical causes ( Colo-Vesical fistulas and son on ..)which would cause communication between two systems?
It looks like Dr.Burton or AJGP has been in hurry to publish this !