I’ve written frequently about the danger CREs–carbapenem-resistant enterobacteriaceae–pose. To recap, CREs are E. coli and its relatives that are resistant to all* penicillin-related drugs (those that start with ceph- or cef-, or end with -cillin or -penem). The bad news is that CREs are usually resistant to many (or very rarely, all) other types of antibiotics as well. These are very difficult to treat and can raise death rates significantly.
Obviously, CREs present problems for the most serious infections, such as bloodstream infections, but one thing I’ve tried to raise is that CREs, if they become more common, will also create significant problems for urinary tract infections (‘UTIs’). In the best case, it will become much more difficult to get rid of annoying/painful UTIs. But, even in otherwise healthy people, UTIs can occasionally develop into serious infections that can cause long-term kidney damage and death.
Because UTIs often live as gut commensals–like most other E. coli–if CREs were to reach, let’s say, one percent of the total human commensal population, then we would face tens of thousands of essentially untreatable UTIs in the U.S. alone.
Which brings us to this disturbing interview with a woman who has had multiple ESBL UTIs–these infections do respond to carbapenems, but are often resistant to most or all other drugs (boldface mine):
I have had kidney reflux, which makes me susceptible to urinary tract infections (UTIs) and kidney infections, since I was a little girl. I only found out that I had an antibiotic-resistant infection when the drug they normally gave me stopped working. I was a teenager when my urine was first sent off to be tested – something I learned should have happened much sooner. The results came back saying there was resistance.
I eventually learned I have painful bladder syndrome, which means that many times I thought my pain was caused by a UTI – and I was given antibiotics to treat it – I actually didn’t have an infection. It is possible I was exposed in hospital during investigations, but it was probably the misuse of antibiotics that caused the resistance….
When the urine culture came back and it said I had a superbug, I didn’t really know what that meant. I thought I had a kidney infection, which was common throughout my childhood. But when I got there, I was put into a side room and several doctors came in, all wearing masks and gloves. That was when it really hit me. My mum and I looked at each other – clearly this wasn’t just a kidney infection.
They had to give me a carbapenem – a last resort antibiotic. It managed to clear that infection. But since then I’ve had more, and I now know that I carry a resistant strain of E. coli known as ESBL E. coli. The doctors have compared it to having MRSA, in terms of how resistant it is to antibiotics. I’ve had to use a carbapenem several times…
It used to be more often, but now it’s every three to four months. I try to avoid taking antibiotics as much as I can. Every time I do have an infection, they culture it to determine what bacteria is causing it – and which antibiotics need to be used. It’s hard, because you have to wait three days for the results to come back, and in that time I can get quite ill, so a lot of time while I’m waiting for the results, I have to be treated like it’s a superbug….
Really the main way it affects my family life is that when I have an attack, it completely wipes me out. When Emerson was a baby, or even now, if he wants to play and I’m unwell, it’s just heart-breaking. It feels like a disability.
While the fight against antibiotic resistance has focused on life-threatening illnesses (for obvious reasons), we must realize that chronic debilitation from UTIs could also be a problem. In terms of raising awareness, deadly infections ring the panic bell, sometimes to the point where many people would rather ignore the problem, but something like UTIs can be used to explain to people how antibiotic resistance can affect their daily lives.