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WHAT CAUSES REPEAT URINARY TRACT INFECTIONS?

0 2 years ago

One of the greatest frustrations regarding urinary tract infections (UTIs) is that they so often recur. UTIs are caused by bacteria in the urinary tract and are characterized by frequent and painful urination.

A round of antibiotics usually clears up the symptoms, but the relief is often temporary: A quarter of women go on to develop a second UTI within six months. Some unfortunate individuals get UTIs over and over and require antibiotics every few months.

The new study in Nature Microbiology shows that a round of antibiotics eliminates disease-causing bacteria from the bladder but not from the intestines. Surviving bacteria in the gut can multiply and spread to the bladder again, causing another UTI.

At the same time, repeated cycles of antibiotics wreak havoc on the community of helpful bacteria that normally live in the intestines, the so-called gut microbiome. Similar to other disorders in which gut microbes and the immune system are linked, women with recurrent UTIs in the study had less diverse microbiomes that were deficient in an important group of bacteria that helps regulate inflammation, and a distinct immunological signature in their blood indicative of inflammation.

“It’s frustrating for women who are coming in to the doctor with recurrence after recurrence after recurrence, and the doctor, who’s typically male, gives them advice about hygiene,” says co-senior author Scott J. Hultgren, professor of molecular microbiology at Washington University in St. Louis.

“That’s not necessarily what the problem is. It’s not necessarily poor hygiene that’s causing this. The problem lies in the disease itself, in the connection between the gut and the bladder and levels of inflammation. Basically, physicians don’t know what to do with recurrent UTI. All they have is antibiotics, so they throw more antibiotics at the problem, which probably just makes things worse.”

GUT MICROBIOMES AND UTIS

Most UTIs are caused by Escherichia coli (E. coli) bacteria from the intestines that get into the urinary tract. To understand why some women get infection after infection and others get one or none, Hultgren teamed up with Ashlee Earl, the senior group leader for the Bacterial Genomics Group, the paper’s co-senior author, and lead author Colin Worby, a computational biologist.

The researchers studied 15 women with histories of recurrent UTIs and 16 women without. All participants provided urine and blood samples at the start of the study and monthly stool samples.

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