Urinary tract infections (UTIs) are very common and becoming harder to treat due to antibiotic resistant bacteria.
Where are these resistant bacteria coming from?
Overuse of oral antibiotics for any suspected infection has historically been thought to be a culprit. Now there's increasing evidence that resistant bacteria are coming from the global food chain, and in particular the poultry industry where antibiotics are commonly used in poultry feed on chicken farms to reduce the risk of E.coli infections.
Drug-resistant E.coli UTIs are increasing in women who are otherwise healthy and have no other risk factors for developing drug-resistant infections. There is increasing evidence that drug-resistant E.coli from antibiotic-treated chicken meat, then ingested by women, may contribute to the emergence of drug-resistant community-acquired UTIs.
Over one third of women will seek treatment for an UTI before age 24, and over half of all women have had at least one UTI in their lifetime. The symptoms are sudden onset of urinary bother with frequency, urgency and burning with urination.
As the infection symptoms escalate, an UTI can become complicated with blood in the urine, severe pain, fever, back pain and worsening infection involving the kidneys.
Women know when they have an UTI and usually seek care within 24 hours of onset of symptoms.
There is good medical evidence to show treating a woman based on her symptoms alone (without a urine culture) is a reasonable option for uncomplicated recurrent UTIs.
But with the emergence of drug resistant organisms, such as the chicken meat, this is being questioned.
If an antibiotic is started without a urine culture, then a provider is making a "best-guess" in choosing an antibiotic. But if the bacteria causing the UTI is resistant to that antibiotic, the "best-guess" antibiotic may mask detection of the original infection on a subsequent urine culture, and the woman's symptoms will worsen, and the opportunity to detect the drug-resistant organism is gone.
The infection will not go away and may escalate into a complicated UTI, requiring stronger antibiotics and possibly an emergency room visit, intravenous antibiotics and even hospitalization.
With the emergence of drug-resistant bacteria, we recommend providers check a urine culture before starting antibiotics for a suspected UTI. That way you know exactly what you are treating and can target exact antibiotic therapy to eradicate the infection.
For women with more than two UTIs in one year, a complete evaluation of her anatomy and urinary tract function should be done by a specialist such as an urologist or urogynecologist.
When the UTI symptoms are occurring in an otherwise healthy woman living in the community with no other risk factors, we recommend reducing all the potential sources of drug-resistant bacteria in their diet. This means eating organic and eating local.
For the health of you, your community, and the environment it behooves us to know exactly where our food comes from and what may or may not have been added along the food's journey to your plate.
Lora Plaskon MD MS
August 18, 2015