A Blog by

Why It’s Crucial the New Superbug Was in a Urinary Tract Infection

Escherichia coli bacteria live in the intestines of humans and are a common cause of urinary tract infections.
Escherichia coli bacteria live in the intestines of humans and are a common cause of urinary tract infections.
Janice Haney Carr, Centers for Disease Control and Prevention

The alarm over the arrival of a grave new superbug in the United States is obscuring part of the story that is crucial to understanding what might happen next. Here it is: The woman who was carrying an E. coli containing resistance to the last-resort antibiotic colistin went for medical care because she had what felt like a routine urinary tract infection, a UTI for short.

The discovery of colistin-resistant bacteria is worrisome: Researchers have been watching for the arrival of this new superbug  for several months. But that it was found in  urine sample puts the discovery into a larger context. Highly drug resistant urinary tract infections happen potentially hundreds of thousands of times a year just in the United States. A small, dedicated corps of researchers has been trying for years to emphasize that these infections represent a serious danger, an unexamined conduit of bacterial resistance from agriculture and meat into the human population, and have mostly been dismissed.

Now that the new-new superbug has thrown light on the problem, will someone listen?

The Centers for Disease Control and Prevention weighed in Tuesday with a statement and a press briefing with health officials from Pennsylvania, where, last week, military researchers said they found the mcr-1 gene in an E. coli bacterium carried by a woman living there.

There are up to 8 million urinary-tract infections in the U.S. each year, and probably at least 10 percent, or 800,000, are antibiotic-resistant.

The MCR gene is important because it represents a breach in the last line of antibiotic defense: It confers protection against colistin, one of the oldest antibiotics out there, and one of the few that continues to work even against bacteria that resist multiple other drugs. Colistin was seldom used in people until recently because it is toxic, but agriculture has been using it enthusiastically for decades, which has seeded resistance through the bacterial world.

And those highly drug-resistant bacteria are turning up in urinary-tract infections. Why UTIs? Because E. coli bacteria are carried in feces, which can easily spread to the urethra and cause urinary-tract infections, especially in women. I’ve written about this several times; the long version in MORE magazine, and, even longer, in a collaborative investigation between the Food and Environment Reporting Network, the Atlantic, and ABC News.

The short version is this: Up to 8 million urinary-tract infections occur in the United States each year, and each year, a growing and significant proportion—hard to measure, but probably at least 10 percent, or 800,000—are antibiotic-resistant.

This has been happening with such frequency that it has actually changed medical practice. Medical specialty societies have been advising doctors for several years now that they should always do a test to determine which antibiotic will work for a UTI, rather than prescribing based on a standard checklist.

But only a few researchers have investigated why that tide of resistance is rising. What they have found is that these resistant UTIs infections are not random and singular, but instead constitute a focused epidemic, caused by particular sets of E. coli that bear the same resistance signatures as ones found in meat animals given antibiotics.

This idea has had difficulty gaining traction, because UTIs are usually dismissed as a minor problem, something that causes a few days of annoyance and requires a few days of antibiotics to fix. (And, not coincidentally, because they overwhelmingly happen to women.) But when UTIs go untreated—which is effectively what happens when the antibiotic administered for them doesn’t work —they climb up the urinary system from the bladder, into the kidneys, and thence into the bloodstream.

At that point, the minor problem becomes literally life-threatening. And resistant UTIs are not only a problem for the individual sufferer: They also pose the possibility of infecting others, if the original victim goes into a hospital for treatment and carries the resistant organism unrecognized in their system.

One reason it has taken so long to recognize this problem is that there is no single surveillance network that could capture all the resistance patterns in all those UTI sufferers, and compare them. There is also the problem of belief: It’s just difficult to imagine that something as minor as a UTI could be the signal of something as grave as a widespread epidemic.

Because of that, the MCR finding in Pennsylvania could end up being fortunate—no only for detecting a grave development early, but also for shining a light on a danger that has been growing, unrecognized, for a while.

5 thoughts on “Why It’s Crucial the New Superbug Was in a Urinary Tract Infection

  1. Thanks for this article, Maryn. It left me better informed as well as a bit rattled! I realize-for regular consumers-the reality is that we are limited in what we can do to protect ourselves from such bacterial infections. Oh, of course we can eliminate all cheap meats and foreign grown vegetables; but to what extent would that even make a difference? Essentially any ground water can become contaminated at some point-in any country on the planet. And realistically, any place where [meat] animals are raised that is not completely friendly to said species to begin with, is gonna make for a necessity (at some point) to use various medications to both protect them and/or keep them alive). thus we have animals full of medications, being raised in stressful situations, (in the case of dairy cows, many are being pushed to produce more and more milk-and then being butchered under various government programs to maintain a certain price level for such meat-yes, they do use/interchange dairy cows with steers for producing cheaper meats/and of course ending up pushing far less healthy supplies in to cheaper supply lines), and facing the problem with a ‘standardized’ chicken breed for large breasts, mass production and a short-c. 6 month-lifespan. It is the corporate way to mass produce and keep a steady supply line of food production moving through the chain. I cannot criticize it as small farming would no longer be able to produce enough food to feed the world-let alone our own country. There are just so many sad realities that go with an ever-widening population and the need for “more and more” of everything. In fact, as one of my nieces went “vegan” some time back. I tried to explain to her the realities of such move from the stand point of attacking all others who are not of her make up? She has never kept a garden (“city girl”) and has no clue of what it takes or how things grow. But I showed her some freshly pulled produce from my own garden one time and then put it in the refrigerator and had her check it out the very next day. Before she could criticize, I asked her to tell me what she saw? When she shockingly observed how quickly it wilted, I asked her how she figured the super markets were able to maintain/protect their vegetables-including organic stuff-for more than a day (to cover picking, shipping, grading and other movements over a week or a month’s time, she shrugged?). Truthfully, if a preservative wasn’t sprayed on these goods, they would never even make it to market. So whether it be e-coli or any number of other bacterial attacks, I can only say God help us all in the very near future. I am incredibly respectful of/and for those who tried their level best, using genius far beyond my conception to create ways…and means for producing, protecting and forever upgrading our food standards to levels of safety unheard of in human history. What is the opposite to such callous torch bearing on my behalf? fear we have been given so many advances that our bodies are no longer able to readjust to the realities that bacteria and viral germs have always been around. However, for most of us, I doubt we will have the resistance to fight off many of these 21st Century progeny to original infection. Our hyper-intelligent individuals who’s efforts have been so extremely important over the past couple of centuries might just come back to bit us…in the end? The colistin-resistant bacteria and other “super bugs” could readily annihilate us in a heart beat and the miracles of science would be left helpless to reshape 7 billion beings’ immune systems to fight them.

  2. As a MD Researcher in the field of urology, I am still surprised that there is so much use of antibiotics for urinary tract infections on a global scale, but very few attention to prevent it or to find alternative non-antibiotic treatments. Bladder residue after voiding is the number one risk factor for bacterial growth and can be improved. But even more important for the future is to focus research on improving tissue barrier in the bladder and urethra to prevent bacterial invasion. The bladder epithelial lining is unique and the most impermeable of the human body and it does this by producing special non-adhering molecules and proteins. We should investigate these compound more and use them to improve the natural barrier of the bladder. The people that investigate this and the budgets available for this are a tiny fraction compared to other diseases. It deserves to get more priority.

  3. Common-or-garden E.coli is naturally resistant to ordinary levels of plain penicillin. As are most (?all) bacteria naturally resistant to some anti-bacterial substances. “Antibiotic resistance” is a natural feature of the complex microbial environment.

  4. I have had an uti for 9 out of the last 12 months, and now I’m having kidney problems and I don’t feel well at all. Is this what is happening to me? I see a specialist this Friday again. I’m bringing this up.

  5. This is not a reply to a specific post, merely a short resumé of my recent experience.

    I am not a medical professional nor am I a scientist.

    End of February 2016 I found I had symptoms of a UTI (I am not particularly prone to this condition my previous UTI having been 4 years earlier). I made an appointment with my GP who took a sample of urine and determined there and then that I had an infection. She put some of the sample on one side to send for laboratory testing and immediately started me on Trimethoprim/sulfamethoxazole which I understand is an antibiotic commonly prescribed for bladder infections. It was a Friday and she knew that she would not receive a report on the lab specimen for several days.
    I took the tablets as prescribed but by Sunday I was feeling very ill. I realised this antibiotic was either making me worse or not having any effect at all. I spoke to a triage nurse on the weekend line who could only advise me to keep on taking the tablets as she had no authority to tell me to stop them. I then made an online appointment with my GP for very early Monday morning to discuss this. However by Monday morning I was too ill to get to the doctor with severe chills, profuse sweats, and a temperature of 39.5. My family called an ambulance and I was assessed in the emergency department of the hospital and admitted. It was established within a few hours that the infection had invaded the bloodstream and I had sepsis. Admitted to the diagnostic ward, where I spent two days, there was no improvement and then my blood pressure dropped lower and lower. I was transferred to the High Dependency Unit with Septic Shock. I was extremely fortunate that, at over 80 years of age, the superb treatment I received in that Unit quite possibly saved me from what could have had a fatal.outcome. It has taken me 3 months to even begin to feel something like normal and just one month after I was discharged from a 10 day hospital stay the infection was back. This time my GP prescribed Augmentin which I believe is a broad spectrum antibiotic and after a week of taking that I recovered without drama.
    Now I don’t know whether I am touching on something sensitive here but I found this small forum under an advertisement for Urofem – d-mannose. At the suggestion of my GP I recently commenced taking this product. Unfortunately during the first week of using these tablets I experienced two severe migraines, something I have not had for many years. Coincidental maybe, I have no way of knowing. The information which is a trifle sketchy about the product stated” no known side effects”. Nevertheless I have stopped taking them.
    Thanks for reading.

Leave a Reply

Your email address will not be published. Required fields are marked *