Stopping and Preventing UTIs

Why do UTIs remain such a significant public health concern despite decades of research and treatment options?

The challenge of UTIs is attributed to overuse of antibiotics, which can lead to antibiotic  resistance, and the formation of biofilms, communities of microbes that often contain pathogens – microbes that cause disease. The biofilms are enveloped in a material that prevents the penetration of antibiotics, so in the absence of new therapeutic approaches, UTIs do and will continue to affect many people.

How would you explain the burden that UTIs place on patients and the healthcare system?

UTIs place a burden on quality of life, generate concern about development of new UTIs and delay diagnoses. The burden on the healthcare system is significant. For example, patients with UTIs have significantly more hospital visits compared with other patients who do not suffer with UTIs.

Are there long-held assumptions about UTIs now being challenged?

Recent studies have revealed that the urinary tract isn't sterile, as many scientists once believed. Instead, it contains a community of microorganisms that help maintain urinary health. Researchers are also uncovering an important link between the gut and the bladder, finding that disruptions to the normal balance of bacteria in the gut may make some people more susceptible to urinary tract infections.

What are the most important findings or insights from your research?

We found that several emerging therapies are showing promise in preclinical studies. These involve probiotics (good bacteria that attack harmful bacteria), methods that disrupt bacterial communication, antimicrobial peptides (natural molecules that help fight infection), and plant-derived compounds. Coupled with the administration of vaccines, these approaches suggest potentially viable strategies for combating UTIs and alleviating the use of antibiotics.

What are biofilms and what role do they play in treating recurrent or difficult infections?

Biofilms are groups of bacteria that stick together on surfaces such as tissue or medical devices. Once attached, they create a protective shield that can make infections harder to treat because they replicate rapidly and are resistant to conventional antibiotics. Among the several different bacteria implicated in UTIs are Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Staphylococcus saprophyticus, and Staphylococcus aureus.

Why has antibiotic resistance become such a pressing issue in UTI treatment, and what did your research reveal about its impact?

Resistance develops through various mechanisms including genetic mutations and production of enzymes that degrade antibiotics. Antibiotic resistance correlates with extended illness and increased mortality. Catheters serve as a breeding ground for infection, increasing the risk for a UTI.

What other conditions/disease states are affected by antibiotic resistance?

Clostridium difficile is a major health care-associated infection in the U.S., causing mild to severe diarrhea. Around half a million people are infected each year, resulting in approximately 15,000 deaths.

Gonorrhea caused by Neisseria gonorrhoea  is a sexually transmitted infection and the second most commonly reported infection in the U.S. It can cause severe reproductive complications if left untreated. Some drugs are becoming less effective in treating gonorrhea, a global problem. 

Vancomycin-resistant Enterococci (VRE) are found colonizing the human digestive tract and female genital tract. VRE infections occur in patients who are in hospitals or other health care facilities. Health care providers commonly use the antibiotic vancomycin to treat Enterococcal infections, but VRE are resistant to the drug.

Tuberculosis (TB) is an often-severe airborne disease caused by a bacterial infection. TB typically affects the lungs, but it also may affect many other organs of the body. Some bacteria are becoming resistant to the two most potent TB drugs. This is known as multi-drug-resistant TB (MDR TB).

Are there new treatment strategies that could reduce reliance on traditional antibiotics, such as novel biological and chemical approaches? What are you developing in your lab?

We are looking at several approaches to reduce reliance on traditional antibiotics. We recently published the benefits of cannabinoids in inhibiting and eradicating biofilms and are also investigating whether "good" bacteria can help fight infection. Early studies suggest that introducing beneficial bacteria may help displace the harmful bacteria responsible for disease, restoring a healthier balance in the body's microbial community.

Are there practical lessons for pharmacists, physicians, and other healthcare professionals from your findings?

The overuse of antibiotics in humans in general has been associated with the increase in antibiotic-resistant infections, a major global public health concern. Similarly, treatment of UTIs has been challenging due to the increase in antimicrobial resistance. New approaches, including using the body's healthy bacteria to help fight infection and developing new infection-fighting drugs, are showing promise.