An ESBL UTI is a urinary tract infection caused by bacteria that produce enzymes called extended-spectrum beta-lactamases (ESBLs). These enzymes break down and destroy many common antibiotics, including penicillins and cephalosporins, making the infections difficult to treat. An ESBL-producing bacterium can colonize the body without causing illness, but if it enters the urinary tract, it can lead to an active infection.
Causes and Risk Factors
ESBL urinary tract infections are caused by bacteria commonly found in the human gut, such as Escherichia coli (E. coli) and Klebsiella pneumoniae. While these bacteria are harmless in the intestines, they can cause infection if they enter the sterile environment of the urinary tract. They produce the ESBL enzyme, which neutralizes many standard antibiotics.
Several factors increase the risk of developing an ESBL UTI:
- Prior antibiotic use, particularly broad-spectrum drugs, which can eliminate susceptible bacteria and allow resistant strains to overgrow.
- Recent or prolonged stays in healthcare facilities like hospitals and long-term care homes, where these bacteria are more common.
- The presence of a urinary catheter, which provides a direct pathway for bacteria to enter the bladder.
- A weakened immune system or other underlying health conditions that make a person more susceptible.
Symptoms and Diagnosis
The symptoms of an ESBL UTI are indistinguishable from those of a standard UTI. They can include:
- A burning sensation during urination.
- A persistent and urgent need to urinate.
- Frequent urination in small amounts.
- Cloudy, strong-smelling, or blood-tinged urine.
- Pressure or pain in the lower abdomen.
Diagnosis begins with a urinalysis to detect signs of infection. If an infection is suspected, a urine culture is performed to grow and identify the specific bacteria.
Finally, antibiotic susceptibility testing is done. This test exposes the bacteria to various antibiotics to determine which are effective. This process confirms if the bacteria produce ESBL enzymes and guides the selection of the correct antibiotic for treatment.
Treatment for ESBL UTIs
Treating an ESBL UTI is more complex because the bacteria are resistant to many standard oral antibiotics. This resistance means initial treatment attempts with common drugs are likely to fail, so the choice of an effective medication is guided by the urine culture and susceptibility test results.
For serious ESBL infections, the primary treatment is a class of antibiotics called carbapenems. These are powerful, broad-spectrum antibiotics administered intravenously (IV) in a hospital setting. Hospitalization may be required for IV administration and to monitor the patient’s response, especially if the infection is severe.
Depending on the susceptibility test results, some oral antibiotic options may be available for less severe infections. Fosfomycin is one such oral antibiotic that has shown effectiveness against many ESBL-producing bacteria. The choice between IV and oral treatment depends on the infection’s severity, the bacteria’s specific antibiotic susceptibilities, and the patient’s overall health.
Prevention and Long-Term Management
Preventing any UTI involves consistent hygiene practices. This includes wiping from front to back after using the restroom, staying well-hydrated to flush bacteria from the urinary system, and urinating shortly after sexual intercourse.
A primary strategy for preventing resistant infections is practicing good antibiotic stewardship. This means only taking antibiotics when prescribed by a healthcare provider and completing the entire course as directed. Stopping treatment early can allow remaining bacteria to survive and develop resistance.
Maintaining open communication with healthcare providers about your medical history, including any prior infections with resistant bacteria, is important. This information helps your doctor make informed decisions about future antibiotic prescriptions. In healthcare settings, diligent handwashing is a fundamental practice to prevent the spread of these bacteria.
Potential Complications
If an ESBL UTI is not treated effectively or if treatment is delayed, the infection can lead to more serious health issues. The bacteria can travel from the bladder up to the kidneys, causing a condition known as pyelonephritis. This is a more severe infection that can cause high fever, chills, and back or flank pain.
A more serious complication is urosepsis, which occurs if the bacteria from the urinary tract enter the bloodstream. Sepsis is a medical emergency that triggers a widespread inflammatory response throughout the body. Symptoms can include:
- Fever and confusion
- Difficulty breathing
- A rapid heart rate
Prompt medical intervention is necessary to manage these complications and prevent long-term damage.