The Threat of Superbugs

Antibiotic Resistance: “How does it impact urology?”

Dr. Thomas Frieden, Director of the US Centers for Disease Control and Prevention, recently told a group of reporters that the next pandemic is "not the thing that we don't know, but something that's hiding in plain sight". (http://cnsnews.com/news/article/susan-jones/cdc-chief-next-pandemic-hiding-plain-sight)  He was referring to the growing problem of antibiotic resistant bacteria.  When patients become infected with such bacteria treatment can be prolonged and complicated.  This problem primarily affects specific patient groups:

• Patients with diseases such as cystic fibrosis that predispose to frequent infections
• Hospitalized patients
• Nursing home patients
• Patients with foreign bodies such as urinary catheters

However, the most concerning issue is that we and others are starting to see such bacteria in our day-to-day practice, occurring in patients who are otherwise in good health.  We find the most common cause is overuse and incorrect use of antibiotics.

A major culprit is use of antibiotics to treat men with “chronic prostatitis”.  While research has shown that the pain such patients experience is rarely caused by an infection (and is not even due to the prostate), men continue to be prescribed repeated courses of antibiotics without any evidence of infection.  This creates 3 potentially serious problems:

• Delay in obtaining the correct diagnosis and treatment
• Direct complications of antibiotic use including severe colitis and tendon injuries
• Development of antibiotic resistant bacteria throughout the body

Although the medical issues are more complex with women who suffer from recurrent urinary tract infections (antibiotics are typically necessary and in some cases long-term, low-dose suppression is indicated) all the same risks exist.

The answer?   Start with a clear diagnosis and understanding of the problem.  While there are times when a short course of empiric antibiotic therapy is an expedient and reasonable choice, long-term empiric antibiotics are almost always a bad idea.  Second, obtain appropriate cultures before treatment.  Although it is often appropriate to treat a healthy young woman who gets an occasional bladder infection without obtaining a culture, women who have frequent problematic infections should always have urine cultures, as should men in essentially every instance.  Third, use narrow spectrum and short course treatment whenever appropriate.   Finally, if infections occur unusually frequently, make sure that they are reinfections (a new episode) and not persistence of the same bacteria within the body; bacterial persistence requires a totally different approach.