Doctors Might Stop Utis From Ever Happening Again
Researchers are using precision medicine to better tackle bacteria in urinary tract infectionsand are pretty sure the method can be applied to other infections, too.
For Scott Hultgren, urinary tract infections are the canary in the coal mine for antibiotic resistance.
Since the mid 2000s, the difficulty of treating UTIs has been steadily rising, Hultgreen, director of the Center for Womens Infectious Disease Research at Washington University School of Medicine in St. Louis, told The Daily Beast. There are around 8 million UTIs diagnosed each year in the United States, making up around 25 percent of all infections.
Most of the time, a course of antibiotics can knock out your average UTI. But for about 25 percent of women, the infection comes back, and develops into recurrent UTIs. A lot of these patients end up getting put on suppressive antibiotic therapy that they take every day, sometimes for months, Hultgren said. Its not an adequate treatment option.
But there might be an alternative therapy. Hultgren is working to develop a precision antimicrobial for UTI. Unlike traditional, antibiotics, which wipe out good and bad bacteria indiscriminately, precision treatments would target the specific bug responsible for the urinary tract infection, while leaving the rest intact.
That FimH is what Hultgren hopes to target using a class of compounds that prevent FimH from binding in the first place, called mannosides.
How Common Are Urinary Tract Infections
Urinary tract infections are very common, occurring in 1 out of 5 women sometime in their lifetime. Though UTIs are common in women, they can also happen to men, older adults and children. One to 2% of children develop urinary tract infections. Each year, 8 million to 10 million visits to doctors are for urinary tract infections.
How Common Are These Infections
C. diff is a major health threat. In 2017, there were an estimated 223,900 cases in hospitalized patients and 12,800 deaths in the United States .
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Database And Data Collection
The National Health Insurance covers about 98% of the South Korean population. The data of the Health Insurance Review and Assessment Service includes information on patient diagnoses, past medical or surgical history, treatment procedures, and prescription dispensing information. We used the National Inpatient Sample of the HIRA , which contains claims data of 13% of randomly selected inpatients. Data of patients who underwent spinal surgery from 2012 to 2016 were collected those with spinal infections were excluded. Of the 71,761 patients, 293 patients were excluded due to spine-related infections and 146 patients were excluded from other types of infections.
The procedural codes of spinal surgery used in this study are described in Table . Outpatient based procedures such as vertebroplasty, kyphoplasty, neuroplasty and nerve block were excluded.
Table 6 Korea Informative Classification of Diseases procedural codes of spinal surgeries included in the study.
Presumed surgery-related CDI patients were identified as those diagnosed with enterocolitis due to C. difficile and required administration of drugs used for CDI, such as metronidazole or vancomycin, within 30 days of spinal surgery.
How Common Are Repeat Cdiff Infections
The rate of repeat infection varies from 5% to 50% among patients with a resolved first infectionthe recurrence rate varies according to risk factors like age, exposure to hospital environments, and an underlying disease like kidney failure. However, the typical recurrence rate among patients is approximately 20%.
Among patients who have already experienced a C. diff infection twice, the rate of reinfection is approximately 45% to 65%.
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Eligible Cases And Controls
The number of potential CDI cases identified in the eligible cohort was 99.During case confirmation, 31 patients were excluded because they resided in askilled nursing facility or long-term care facility. Thus, the number ofconfirmed CDI cases was 68. Two potential controls were selected per potentialCDI case, resulting in 198 potential controls. Following confirmation, 62 wereexcluded because they resided in a skilled nursing facility or long-term carefacility. In addition, 24 were excluded because they did not have antibioticexposure during the 90-day period before their index date, because case-controlmatching was not to the exact day. Thus, the number of confirmed controls was112.
What Antibiotics Treat Cdiff
Although broad-spectrum meds are at the top of the list of C.Diff causes, there are only a few types of C.Diff antibiotics capable of curing this particular infection. Vancomycin is the most frequently used antibiotic for C.Diff, says Dr. Prouty, citing the importance of oral, as opposed to IV, treatment: The IV doesnt actually penetrate the gastro-intestinal system, so its pretty much useless. And since all infections are caused by different microbes , not all antibiotics are going to target those microbes and kill them, she says. Therefore,specific drugs must be used in C.Diff treatment.
It has been suggested thatrates of C.diff have fallen in recent years at least partially due toantibiotic stewardship programs in hospitals, which seek to reduce the prescribing of unnecessary antibiotics. But when it comes to patients being proactive over C.Diff prevention, Dr. Akselrod says the number one thing they can do is have a frank conversation with their medical provider about whether or not they really need that antibiotic, and to minimize the time spent on it.
Symptoms Of A C Difficile Infection
Symptoms of a C. difficile infection usually develop when you’re taking antibiotics, or when you’ve finished taking them within the last few weeks.
The most common symptoms are:
- watery diarrhoea, which can be bloody
- painful tummy cramps
- signs of dehydration, such as a dry mouth, headaches and peeing less often than normal
- a high temperature of above 38C
- loss of appetite and weight loss
In some cases, serious complications can develop, such as damage to the bowel or severe dehydration, which may cause drowsiness, confusion, a rapid heart rate and fainting.
Antibiotics And Risk Of C Diff Recurrence
Most antibiotics carry a risk for C. diff infections, however, some antibiotics carry a higher risk due to their spectrum of coverage. The below table provides select antibiotics and their associated risk level for C. diff recurrence.
- Loss of appetite
Gut Bacterial Community Structure During Uti Treatment
In order to test our presumption that parenteral administration does not disrupt the gut microbial communities, we analysed faecal microbiota composition in three patients 1) in the course of their UTI treatment with gentamicin. Although there was some variability in diversity between individuals ,2), it was not statistically affected by this UTI treatment .
If C Diff Is Caused By Antibiotics How Do Antibiotics Treat It
Not everyone who has this infection needs treatment. About 20% of patients see their symptoms disappear just a few days after they stop taking the antibiotic that caused it in the first place. The other 80% need active treatment.
It may seem odd to treat a condition caused by antibiotics with more antibiotics, but since Clostridioides difficile is a bacterium, antibiotics are the only way to treat the infection. At this point, there are only two effective antibiotics, vancomycin or fidaxomicin.
Researchers are looking at a newer treatment called fecal transplantation or bacteriotherapy. Stool from a healthy person is collected and inserted into the infected patients colon, much like a colonoscopy. Another approach is to place the stool in capsules, which the patient swallows.
Fecal transplant is not completely new some hospital systems have been using the treatment since 2012. However, its understandable that a patient may be wary about the procedure, as it is out of the norm. However, a study published in 2013 in the New England Journal of Medicine showed that this approach was more effective than the antibiotic vancomycin in treating repeat C. difficile infection.
How Does It Spread
The C. diff bacterium comes from feces. You can develop an infection if you touch a contaminated surface and then touch your mouth.
In addition, the spores of C. diff are resistant to many chemicals used for cleaning. As a result, they can stick around for a long time.
While anyone can develop a C. diff infection, some people have an increased risk.
Things that can increase your risk include:
- taking antibiotics, especially a long course of broad spectrum antibiotics
What Stands Out About Yale Medicines Approach To C Diff
At Yale Medicine, our physicians are at the forefront of preventing C. diff infections. We have rolled out a new initiative to prevent the unnecessary prescribing of antibiotics for hospitalized patients, and we are starting to use an antibody that reduces the risk of C. diff relapse, says Dr. Grant.
How You Get C Difficile
C. difficile bacteria are found in the digestive system of about 1 in every 30 healthy adults. The bacteria often live harmlessly because the other bacteria normally found in the bowel keep it under control.
However, some antibiotics can interfere with the balance of bacteria in the bowel, which can cause the C. difficile bacteria to multiply and produce toxins that make the person ill.
When this happens, C. difficile can spread easily to other people because the bacteria are passed out of the body in the person’s diarrhoea.
Once out of the body, the bacteria turn into resistant cells called spores. These can survive for long periods on hands, surfaces , objects and clothing unless they’re thoroughly cleaned, and can infect someone else if they get into their mouth.
Someone with a C. difficile infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up.
So How Do We Prevent C Diff Infections
We cant prevent all infections, but we can reduce the chance of contracting C. diff by only taking prescribed antibiotics and not someone elses, even if you believe you have the same type of infection. Wash your hands frequently and well. And if you suspect you have C. diff, contact your doctor right away.
If you do have a C. diff infection, watch for signs of sepsis. If you think you may have sepsis, seek help immediately by going to your closest emergency room or calling 911.
Learn more about C. diff and other conditions that can lead to sepsis at the library.
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Which Antibiotics Cause Cdiff
So how exactly does antibiotic usage make one susceptible to a life-threatening disease like C.Diff? When you take an antibiotic, it works to kill a bacterial infection in your body. In the process, these drugs can also destroy the healthy bacteria that keep invaders like C.Diff in check. Its important to note, not all antibiotics cause C.Diff, and not everyone has the same risk. Although almost any antibiotic can cause it, the worst culprit, in this case, is often broad-spectrum antibiotics. Those most at risk are patients 65 or older who have been in a healthcare setting, such as a hospital or nursing home.
Broad-spectrum antibiotics have activity against a range of bacteria that reside in the gut, explainsDr. Hana Akselrod, assistant professor of medicine in the Division of Infectious Disease at theGeorge Washington School of Medicine and Health Sciences. Its very important to have a healthy and diverse population of these bacteria. When people are given broad-spectrum antibiotics, their gut bacteria are depleted, thereby allowing for a pathogenic species, such as C.Diff, to essentially create overgrowth of aggressive bacteria that produce toxins that damage the bowel and create very severe illness.
Both Dr. Akselrod and Dr. Prouty identify clindamycin and fluoroquinolones as some of the worst offenders. The list of antibiotics that could cause C.Diff includes:
C Diff Infection Recurrence Is Most Likely In Individuals Who Are
- exposed to hospitals and long term care facilities, especially repeatedly or for prolonged periods of time. These environments are often sites of bacteria proliferation.
- over the age of 65. The exact reason for more cases of C. diff in individuals over the age of 65 is unknown, but it is possible a weakened immune system may inhibit the bodys ability to fight a C. diff infection.
- starting, finishing, or currently taking a course of antibiotics not related to C. diff treatment. Antibiotics can disturb the healthy balance in the gut, especially acid composition in the colon which promotes C. diff growth.
- completing a course of antibiotics related to C. diff treatment. For those who have had C. diff in the past, antibiotics, like vancomycin, are prescribed to target toxin-producing C. diff bacteria. However, there may be other dormant forms of the bacteria that remain in the gut. Once a course of antibiotics is complete, the dormant C. diff spores may become active, causing recurrence. For example, C. diff recurrence after a course of vancomycin is common. Antibiotics, like investigational drug ridinilazole, meant to target C. diff bacteria specifically may potentially reduce chance of repeat infectiondestroying C. diff bacteria without disturbing healthy gut balance.
- taking medication to reduce stomach acid. Lowered acidity in the gut may increase the risk of a C. diff infection.
- suffering from weakened immune system and/or severe underlying illness
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Clinical Policy And Research Implications
Our findings suggest that GPs consider early prescription of antibiotics for this vulnerable group of older adults in view of their increased susceptibility to sepsis after UTI and despite a growing pressure to reduce inappropriate antibiotic use. Particular care is needed for the management of older men and those in deprived communities. For researchers, there is a need to improve the understanding of the effects of deferred antibiotic prescribing in routine practice. New medical record or retrievable codes should therefore be in place to record when primary care clinicians advise patients to delay antibiotic consumption.
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Analysis Of The Faecal Microbiome
To characterize the bacterial community, DNA was extracted from 250300mg faecal samples, using the MoBio PowerSoil DNA isolation kit . The V5V6 hypervariable regions of the 16S rRNA gene were amplified using the BSF784/1065R primer set and paired-end sequenced at the University of Minnesota Genomics Center to a read length of 300nt.10 Raw sequence data were deposited in the NCBI Sequence Read Archive under BioProject accession number SRP077993. Sequence processing and analysis were performed using mothur software .11 Sequences were paired-end joined and trimmed for quality as described previously.12 High-quality sequences were aligned against the SILVA database and subjected to a 2% pre-clustering step, and chimeras were removed using UCHIME.1315 Operational taxonomic units were assigned at the 97% similarity level using the furthest-neighbour algorithm and taxonomic classification was performed against the Ribosomal Database Project classifier .16 For unbiased group comparisons, samples were rarefied by random subsample to 65450 sequences per sample.17
Treatment For C Difficile Infection
Doctors use specific antibiotics to treat C. difficile, usually metronidazole first. If metronidazole doesnt work, the second medication is usually vancomycin . A more costly antibiotic, fidaxomicin , may be effective if neither metronidazole or vancomycin has worked.
In severe cases, a surgeon may need to remove the affected part of the colon.
Testing is ongoing for a new procedure called fecal microbiota transplant , or a stool transplant. Physicians introduce a donors stool into the affected persons colon with a colonoscope or nasogastric tube. Researchers are also trying capsules as a better delivery method.
Are There Any Complications
While most C. diff infections dont cause any long-term problems, more serious ones can lead to complications, such as:
- Toxic megacolon. Toxic megacolon is a rare condition that causes a grossly enlarged colon. Left untreated, your colon can rupture. This can be fatal.
- Bowel perforation. Damage from the infection or toxic megacolon can cause a hole to form in your intestines.
- Kidney injury. In severe cases of C. diff infection, rapid dehydration can lead to acute kidney injury.
Despite its resistance to many cleaning products, there are several things you can do to prevent yourself from developing or spreading a C. diff infection.
Follow these tips to reduce your risk:
- Wash your hands regularlywith soap and warm water. This is especially important after using the bathroom and before eating.
- Dont take antibiotics unnecessarily. Keep in mind that antibiotics are only effective for bacterial infections and wont treat a viral infection, such as the flu or common cold.
- Keep surfaces in high-use areas clean. This includes bathrooms and kitchens. Try to periodically clean these areas with products containing bleach. Bleach is effective against the C. diff bacterium.