About antibiotic-resistant urinary tract infections

Antibiotic-resistant urinary tract infections are a type of infection that do not respond to most – or any – of the most common treatments. Find out more about antibiotic-resistant urinary tract infections and the care patients will receive.

Have you ever been diagnosed with an antibiotic-resistant urinary tract infection (UTI) which is essentially an infection of your water works? This uncomfortable and often painful infection affects 10-20% of women at some point in their life, and some men, too. You can find out more about UTIs in general on our common infections page, or read on for information about antibiotic-resistant UTIs.

Antibiotic resistance occurs when the bacteria causing an infection either develop or acquire a mechanism that protects them against antibiotic treatments.

Those at greatest risk of antibiotic resistant infections are often those with other underlying medical conditions, have weakened immune systems either due to illness or as a side-effect of current treatment. Those often affected have already been taking antibiotics or have been in hospital. Older people, such as those in care facilities or those undergoing catheterisation may also be affected by ongoing or recurrent resistant UTIs.

The biggest risk is that untreated or resistant infections can lead to kidney problems (like pyelonephritis) or even more serious conditions like sepsis (or urosepsis). However, it is also very difficult living with the ongoing symptoms of recurring or antibiotic resistant UTIs.

The most common bacterial cause of UTIs are E coli. These bacteria usually live harmlessly in the gut of healthy people but can cause problems if they get into the bladder or other parts of the urinary tract. Uncomplicated infection of the bladder, also called cystitis, is common and can be very painful.

Some strains of E. coli bacteria have begun to produce enzymes called extended-spectrum beta-lactamases (often summarised to ESBL E coli). These can make the bacteria resistant to certain antibiotics, and so the bacteria continue to multiply and spread. This causes more severe infection which becomes much more difficult to treat. Another type of bacteria which often causes antibiotic resistant UTIs is ESBL klebsiella pneumoniae. You can read more about extended-spectrum beta-lactamase-producing bacteria (ESBLs) here.

E. coli belongs to the Enterobacteriaceae family of Gram-negative bacteria. This family of bacteria also include klebsiella pneumoniae and enterobacter cloacae. The Enterobacteriaceae family can all cause UTIs and are often treated with the beta-lactam antibiotic, carbapenem, for which there are specific ESBL enzymes. The carbapenem resistant Enterobacteriaceae (CRE) that have developed, have become a real risk to health as the main antibiotic becomes useless and their presence increases in hospitals and care settings.

You can find out more about the symptoms of a UTI on our common infections page. The main difference between a regular UTI and an antibiotic-resistant UTI is that the medicines usually used to treat such infections do not often work against antibiotic-resistant UTIs. While the antibiotics may appear to work at first, they are only killing those bacteria sensitive to the antibiotic, but not dealing with the resistant organisms. This means it is really important that if antibiotic resistant bacteria are present, they are diagnosed and identified as early as possible so the right antibiotics are used to kill them.

To identify if you have a UTI, your doctor will usually ask you to provide a urine sample. They will test your sample with a dip stick. This is a quick way to establish if you have a urine infection. If positive, then a sample of your urine will normally be sent to the local microbiology laboratory for testing.

You cannot pass a UTI on to another person. However, if you have an infection of any type – particularly one that is antibiotic resistant – there is always a risk that the bacteria causing the infection could infect those around you if you do not adhere to proper hygiene standards. If you have an ESBL resistant infection, you will often be kept in isolation in a hospital ward, to decrease the risk of spreading these bacteria to other vulnerable patients. For prevention of UTIs, it is particularly important that you wash your hands after using the bathroom and after sexual contact, and maintain a clean environment.

Find out more about what you can do to prevent the spread of harmful bacteria.

For most common UTIs, there is usually a ‘first-line’ antibiotic that is often used as standard, although these vary across the UK. If you have had a UTI, the chances are you are familiar with these drugs. So GPs will usually follow guidance to treat a UTI immediately with first line therapy according to local guidelines. If this doesn’t eliminate the infection, a urine culture is often sent to the lab to test what the bacteria actually is and what antibiotic is likely to kill it. Other antibiotics such as fosfomycin and pivmecillinam might be used where first line antibiotics have not worked. Fosfomycin is an oral broad-spectrum antibiotic that acts against many multidrug-resistant pathogens in the urinary tract.

When people have had several UTIs, and several courses of antibiotics for a UTI, antibiotics may initially appear to work and symptoms often resolve for a while. However, the more resistant organisms are known to sometimes attach themselves to the bladder wall as well as forming colonies of resistant bacteria within other parts of the body such as the kidney.

These colonies of resistant bacteria can multiply in number over time, and become immune to the effect of the antibiotics. The bacteria become harder to eradicate, even when taking powerful antibiotics, as they form a biofilm. This is where the colonies of resistant bacteria form a protective layer around themselves, making it even more difficult for antibiotics to reach and kill them.

An antibiotic resistant UTI can then become a chronic condition and can often cause frequently recurring outbreaks of infection, with an increased risk of serious kidney infection (pyelonephritis) and even sepsis.

Some strains of bacteria are now resistant to all of the most commonly used antibiotics. When UTIs recur or don’t go away with treatment, urine samples are usually tested at a microbiology lab. If resistant organisms are discovered they are often found to be ESBL E. coli or ESBL Klebsiella. If you have a UTI with either of these resistant bacteria, you will probably be treated in hospital by an infectious disease doctor and their team. They will often prescribe a specific antibiotic via an intravenous (IV) drip (or combination of antibiotics) known to be active against ESBL- producing bacteria. This might be carbapenem antibiotic. These are considered ‘last resort’ antibiotics which are kept especially for those highly resistant bacterial infections.

If you have an antibiotic-resistant UTI, you’re not alone. There are many different support groups online where people suffering with resistant UTIs can help one another.

Many of those who suffer with recurring or resistant UTIs are keen to reduce the risk or occurrence. They try using natural products to help with their symptoms. These include D-Mannose, cranberry products (like triple strength tablets or juice), Kefir /probiotics, manuka honey and so on.

Anecdotally, many report finding some of these useful in the prevention of UTIs; however, there is very little published evidence to support the effectiveness of these natural products, and more research is needed.

The speed at which an infection spreads depends on many factors. This includes the type of bacteria causing the infection and how long they infection has been present for. The genetics of the bacteria involved and the health and habits of the person affected is also a factor. It remains important to maintain good hygiene and follow the advice of your doctor or clinical specialist. You should also let them know if you notice any changes in your condition. The biggest risk is that the infection is not treated quickly enough or effectively. This can also increase the risk of developing kidney infection, inflammation or urosepsis increases. When the bacteria spread from the urinary tract or bladder into the bloodstream, it is commonly called urosepsis, and can be very serious.

If your question is about your own health, please contact your GP or medical specialist treating you.

Are you feeling unwell but the problem is not a medical emergency? Call 111 (or your own local Out Of Hours telephone number) to find out whether you need to attend hospital.

If you are experiencing a health emergency, you should call 999 or attend your nearest accident and emergency. Make sure you take all of your medications with you.

If you are not seeking health advice, but would like to talk to someone who understands antibiotic resistance and can help you find more information, get in touch with our Patient Support Team.

Contact our Patient Support team on patient.support@antibioticresearch.org.uk or call them on 07367 784114. Calls are charged at your usual mobile or landline rate. However, you can request a call back by text, email or by leaving a message.

Explore our website to find out more about antibiotics, bacteria and the common infections they cause, and our research.

Hear real life stories from patients that have suffered with an antibiotic resistant UTI.

Disclaimer: Any medical information referred to in or through our website is given for information purposes only. It is not intended: to constitute professional advice for medical diagnosis or treatment; to replace consultation with a qualified medical practitioner; to advocate or recommend the purchase of any product; or to endorse or guarantee the credentials or appropriateness of any health care provider. You are strongly advised to consult with an appropriate professional for specific advice tailored to your situation. Instead, information provided on our website is intended to provide helpful signposting towards further information and support. We aim to provide an opportunity for you to simply share and discuss matters relating to antibiotic resistance with our Patient Support Officer.