Antibiotic Resistance In Kidney Infections: Implications For Treatment

Introduction

Nowadays one of the most important societal health problems is antibiotic resistance. As the consequences of antibiotic resistant infections lead to hospitalisation. Every year nearly 300 million medical consultations in the UK and 490 million in the USA are regarding the urinary tract infection (UTI) which is 1%-3%. Furthermore, it is the second most common disease for which antibiotics are prescribed.

Pyelonephritis, sepsis and renal abscess are serious complications caused by UTI and are common in older people and immunocompromised individuals and can lead to longer-term health complications or death UTI is more common in women than men but it is often more complicated for men and requires more attention. In addition, if a bacteria that is resistant to antibiotics is causing the UTI, this complicates limits treatment options.²

Background on kidney infections

What is an antibiotic-resistant UTI?

Majority of UTIs can be treated by antibiotics prescribed by the doctor but if you have an antibiotic resistant UTI infection in your bladder, urethra and kidneys then the most commonly used antibiotics are unlikely to be an effective treatment.³

E.coli is a bacteria that causes most of the UTIs and antibiotics can be used to treat the infection. However, some strains of the E.coli produce enzymes known as extended-spectrum beta-lactamases (ESBLs). These enzymes break down and eliminate certain antibiotics, which will make the treatment ineffective. 

The doctor will normally prescribe antibiotics for UTI infection without knowing the bacteria is a resistant strain. You may feel better initially, due to the antibiotics eliminating some of the bacteria (which may be non-resistant), but ultimately the resistant strain will multiply and cause a recurrence of symptoms. Then, if the doctor discovers the UTI is caused by a resistant strain, they will need to change the antibiotic for a stronger one. The good news is that we do have antibiotics that work on most resistant strains. 

What is kidney infection? 

Pyelonephritis a kidney infection, which is often caused by the bacteria travelling further up the urinary tract from a lower UTI.⁴ 

How do kidney infections occur?

The kidney produces urine to remove waste in the body. The urine travels from the kidneys, through the ureters and into the bladder, where it travels through the urethra to exit the body. Usually, the movement of the pee from the tubes usually clears out any bacteria.⁴ 

Now the bacteria sometimes travels upwards into the body and infects parts of the urinary tract including the urethra, bladder or ureters. Also, From there the bacteria travels to the kidneys which will result in kidney infection. The bacteria that arrives from the blood from other parts of the body can also lead to kidney infections.⁴

Types of pathogens that cause kidney infections

Bacteria is the main culprit for kidney infections. Types of bacteria that cause kidney infections are:⁴

• E. coli
• Proteus mirabilis
• Enterobacter
• Staphylococcus

Symptoms of kidney infection

• Fever
• Chills
• Pain in lower back
• Needed to pee often
• Pain when peeing
• Bloody or cloudy pee

Understanding antibiotic resistance

What is antibiotic resistance? 

To treat bacterial infections antibiotics are given The usage of antibiotics can change the bacteria itself, making it resistant to antibiotics. The bacteria evolve and cease to respond to the drugs, causing the infections to be more difficult to treat and this causes the infection to become worse. The bacterium's ability to handle and tolerate the effects of antibiotics is known as bacterial resistance.⁵

Furthermore, antibiotic resistance is becoming a worldwide issue, where antibiotics are no longer effective in treating infectious diseases. To stop and treat infectious diseases in humans, plants and animals medicines known as antimicrobials including antibiotics, antivirals, antifungals and antiparasitics were created.⁶

Factors contributing to antibiotic resistance

Over time bacteria naturally become resistant to medicine. As well certain factors can speed up the mechanisms, including:³

Overuse of antibiotics

Antibiotic resistance occurs when you consume antibiotics that you don't need to take. E.g. taking antibiotics to help a sore throat which is caused by a virus.³ 

Misuse of antibiotics

Bacteria take any benefit to multiply if given the chance. The unwell person might forget to take their antibiotics, stop treatment too soon or take someone else's medicine. The bacteria starts reproducing and mutating. Mutated bacteria become rapidly resistant to medicine. The antibiotics will kill bacteria that are not mutated to resist treatment but leave resistant bacteria.³

Transmitted resistance

Contagious drug-resistant bacterial infections can pass between individuals. The individual now has an infection that cannot respond to the antibiotic. Most of the time treatment will work on it but as time passes the resistant bacteria evolve to be harder to treat.³

Spontaneous resistance

Happens when the DNA of the bacterium starts to evolve or mutates by itself. Hence, the antibiotic does not realize the changes happening in bacteria and cannot target it properly. The alterations aid the bacterium to fight off the medicine.³

Impact of antibiotic resistance on kidney infections

Kidney infections can result in life-threatening complications for individuals who are immunocompromised or have other health issues.⁴ 

Current treatment approaches for kidney infections

The doctor will prescribe you one or more antibiotics to treat the kidney infections depending on the bacteria present. This may include:⁴

• Trimethoprim-sulfamethoxazole (TMP-SMX)
• Amoxicillin or co-amoxiclav
• Ceftriaxone or cephalexin
• Ciprofloxacin or levofloxacin

Prevention against kidney infections

Below are some tips to avoid getting infections in any area of your urinary tract:⁴

• Maintain good hygiene
• Pass urine after sexual intercourse
• Drink a lot of fluids
• Empty your bladder regularly

Strategies to combat antibiotic resistance 

Recently various researchers globally are aiming to develop solutions to combat antibiotic-resistant bacteria (ARB) as a means to prevent the situation of effective antibiotics from becoming clinically unavailable in the future.⁷

The new advanced strategies to fight the rise of the ARB are:⁷

FAQs

Can I prevent getting UTI by consuming natural products?

Individuals who suffer from recurring or resistant UTIs take D-Mannose, cranberry products, kefir/probiotics, manuka honey. Also, many findings report that they are useful in preventing UTI but there is no official guidelines to support use of these products.

What happens if I have a multidrug-resistant urinary tract infection?

Some bacteria strains have enzyme ESBL which makes antibiotics ineffective in killing them. So if there is a recurring UTI urine sample will be taken to determine if it is ESBL E.coli or ESBL Klebsiella. Then the doctor will give you specific antibiotics through intravenous (IV) drip which will combat the ESBL producing bacterias. These types of antibiotics are kept as a last resort only given to highly resistant bacterial infections.

Summary 

Antibiotic resistance is a growing health concern, especially for urinary tract infections (UTIs), which are very common in both the UK and the USA. These resistant infections can lead to severe complications, particularly for older adults and those with weakened immune systems. Kidney infections, often stem from resistant bacteria like E. coli, making them tough to treat. Symptoms include fever, chills, and pain. To prevent these infections, it's important to maintain good hygiene, stay hydrated, and use antibiotics correctly. Researchers are working on new treatments like vaccines and probiotics to combat antibiotic resistance and preserve the effectiveness of current antibiotics.