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Urinary tract infections (UTIs) are one of the most common infections in the world that will affect one in four women during their lifetime.
While most UTIs can be remedied with antibiotics, that’s not the case for everyone. For those who suffer from superbug or antibiotic-resistant bacteria infections, this painful inconvenience becomes something that can control their life — and can have harmful health effects.
Victoria Marshall, a retired librarian, began experiencing chronic UTIs when she turned 65.
"There'd be very sharp burning almost all of the time, urgency and occasional dampness," the now-72 year-old said in a recent interview with CTV News. "I couldn't go out of the house for more than an hour at a time, without knowing where a bathroom was."
But a new trial out of Toronto's St. Joseph’s Hospital, helmed by Dr. Greg German, is looking to address chronic UTIs using phages — viruses that target and kill bacteria. It has already seen success with the first Canadian study of its kind.
Marshall participated in the study, and had billions of phages injected into her bladder. They were also sponged onto her vaginal area, and ingested to deliver them to her urinary tract.
"I started to feel better within about 48 hours," said Marshall, who remains infection-free months later. "I've been feeling like a new woman."
I can have my life back... It's been really hard.Victoria Marshall, 72, via CTV News
When Marshall learned she had been "biologically cured" she cried tears of joy. "Well, I can have my life back," she said. "It's been really hard."
Read on for everything you need to know about superbug infections and how to address them.
What is a superbug infection?
A superbug infection, also known as an antibiotic-resistant infection, is a bacterial infection that does not respond to antibiotics. There are different kinds of superbug infections that can cause pneumonia, skin infections and UTIs.
"All of us have bacteria in the urinary system, that's normal," Dr. Rupert Kaul, a senior scientist at Toronto General Research Institute and Professor in the Departments of Medicine and Immunology at the University of Toronto tells Yahoo Canada. "But sometimes those bacteria can build up to a level where they actually cause symptoms."
As Kaul explains, there are two kinds of urinary infections; cystitis is one type of benign infection that causes painful urination and usually goes away on its own. A second, more severe kind of infection called pyelonephritis occurs when the infection goes higher up into the urinary system to involve the ureter or the kidneys.
"That can be quite severe," Kaul says, "and that can lead to those bacteria causing permanent kidney damage or getting into the bloodstream and causing sepsis or even sometimes septic shock."
Antibiotic-resistant bacteria can be found on this spectrum, in both minor and more severe infections.
What can cause antibiotic-resistant UTIs?
According to Kaul, there have been progressive increases in antibiotic resistance for UTIs over time.
In 2019, The New York Times reported that the majority of UTIs are resistant to one or more antibiotics.
The most common bacteria in a cystitis infection is e.coli, and over time, the bacteria has adapted to resist existing antibiotics. In addition, our own personal resistances have built up after repeated antibiotic use.
How do I know if I have a superbug infection?
Kaul says you won't know if you have a superbug infection until you see your doctor.
"The only way that you would think that you had [a superbug infection] is that you have symptoms of infection, in this case, pain when [you're] urinating, or fever, and it keeps coming back despite taking the standard antibiotics," Kaul explains.
Your physician will prescribe antibiotics and test bacteria from your urine to determine whether or not the bacteria is antibiotic-resistant.
If bacteria is antibiotic resistant, Kaul says "that [patient] might need to go into the emergency department in order to access intravenous antibiotics, something that they couldn’t get from their family doctor."
What are the signs of a severe UTI?
If a UTI moves towards the kidneys, there will be some pretty clear signs — regardless of whether it's a regular or antibiotic-resistant infection. Symptoms of a kidney infection may include:
blood in the urine
pain in the kidney area that may feel like back or flank pain
Kaul says these symptoms "suggest that there's an invasion into the bloodstream and that [the UTI] could be developing a much more severe infection."
How do you address treatment-resistant UTIs?
It takes a bit of trial and error when it comes to treating superbug infections. If the first line of antibiotics fails to make an impact, a physician will most likely collect a urine sample to determine which bacteria is present and develop a treatment plan.
Sometimes, if there is an antibiotic-resistant bacteria that is, or has become, common in the population, Kaul says doctors will start two antibiotics at the same time in order to double the chance it's addressed quickly. It's not always easy — or quick — to help patients address treatment-resistant infections.
"We do have a number of newer antibiotics recently that have been specifically designed to cover antibiotic-resistant bacteria," Kaul says. "We have a pipeline issue in the sense that many of those antibiotics are not approved in Canada."
Kaul says this can lead to a "significant delay" in getting ahold of the correct antibiotics that would help a treat a patient's infection.
While phages, used in Dr. German's trial, may work to treat chronic or recurring UTIs, Kaul notes it's not easy for doctors to use in emergency situations or in the day-to-day to address patient's needs. It takes time to identify and then grow specific phages for specific types of bacteria.
In the very best of circumstances, Kaul says, it can take weeks or months from when a bacteria is identified to when doctors can get ahold of the correct bacteriophage.
While there's still work to be done when it comes to effectively and completely addressing antibiotic-resistant infections in the urinary tract, this recent trial is yet another step in the right direction.