Antimicrobial Resistance Makes It Harder to Treat Urinary Tract Infections and Increases Risk of Sepsis and AKI

UTIs occur when bacteria enter the urethra and infect the urinary tract, and are more frequent in women—between 40% to 50% of women have reported having at least one UTI in their lives. Risk factors for developing a UTI can also include older age, family history and genetics, procedures, and catheterization.

UTIs are generally classified as either complicated or uncomplicated.

Uncomplicated UTIs typically occur in healthy, non-pregnant, pre-menopausal women. Complicated UTIs, however, have the potential to progress to more severe disease associated with risk factors that that decrease the effectiveness of antibiotic treatment. These risk factors include conditions such as structural or functional urinary tract abnormalities, immunodeficiency, or medical devices that harbor biofilm (to name a few). These conditions can lead to initial treatment failure and place the patient at risk for developing complications (e.g., urinary tract injury, abscess, etc.) or more serious disease. Uropathogenic Escherichia coli (UPEC) is the most common causative pathogen for both types of UTIs.

It is important to understand the significant correlation between antibiotic resistance and UTI infections. As summarized by Lisa Bebell, an infectious disease physician at Massachusetts General Hospital, “antibiotic resistance is a huge problem for UTIs, compared to other infections, because UTIs are so common. So, we see the effects of antibiotic resistance much more immediately and with a higher prevalence.” One 2019 study states that more than 92% of bacteria that cause UTIs are resistant to at least one common antibiotic, and almost 80% are resistant to two.

UTIs that are more likely to be complicated and resistant to antibiotics include catheter-associated urinary tract infections (CAUTI). CAUTI are the most common healthcare-associated infection (HAI) and cause of secondary bloodstream infections. CAUTI, which are defined as, “urinary tract infections occurring in an individual whose urinary bladder is catharized or has been catharized within the past 48 hours”, can be dangerous due to alarmingly high rates of antibiotic resistance.

CAUTI remain a severe healthcare burden. During a research study to further understand the progressions of biofilms and urinary catheters, antibiotic resistant genes were detected in half of the samples taken. An increased prevalence of resistant infections around the world is resulting in antibiotics that are commonly used to treat UTIs such as ampicillin, nitrofurantoin, and ciprofloxacin, failing as treatment options. If an infection is not adequately mitigated it can progress into a serious, life-threatening condition called sepsis.

UTIs, including CAUTI infections, are one of the most common causes of sepsis. About 60% of patients with septic shock develop acute kidney injury (AKI), which is associated with high morbidity and mortality. AKI causes a build-up of waste products in blood, making it hard for kidneys to keep the right balance of fluid in the body, which can affect other vital organs such as the brain, heart, and lungs.

With UTI-causing bacteria becoming increasingly resistant to many antibiotics, it is daunting to envision a future in which even more UTI leads to sepsis, AKI, and possibly death due to a lack of treatment options. There are many ways, however, that we can work to minimize these risks.

UTIs can be diagnosed through diagnostic tests such as urinalysis or urine culture. Diagnostics that aid in identifying pathogens and antimicrobial resistance for those suspected of having UTI is crucial to ensure the patient is prescribed the proper treatment for their infection. Other diagnostic tests such as blood cultures can be critical in diagnosing sepsis quickly in patients.

Surveillance tools can be critical to tracking antibiotic resistant bacteria in healthcare settings. According to the CDC, “consistent tracking and reporting of symptomatic UTIs using surveillance criteria will help identify opportunities to examine, understand, and address differences between surveillance events and clinically identified events.”

Initiatives such as antimicrobial stewardship programs (ASPs) can also play a significant role in better patient outcomes and preventing the spread of AMR by limiting antibiotic misuse and overuse in this setting. ASPs rely on appropriate diagnostic information, as well as institutional data obtained from surveillance tools, to aid in the appropriate use of antibiotics.

We must encourage the use of diagnostic tools, surveillance, further research, and select appropriate treatment methods to help mitigate antibiotic resistant UTI infections and protect patients from increased risk of complications and associated mortality.

Opinions expressed in this article are not necessarily those of bioMérieux