Urinary tract infections: antibiotics and your microbiota in question?

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Do you suffer from repeated urinary tract infections and do not know what is causing it? In France, approximately 2 million women are subject to repeated episodes of urinary tract infections. A new study published on May 2 in the journal Nature Microbiology affirm that antibiotics could be the cause of these recurrent UTIs.

This is the first time that a study has shown that antibiotics used to treat urinary tract infections could actually promote recurrence of infections by eliminating pathogenic bacteria from the bladder, but not those of the intestines. Surviving bacteria in the gut can then multiply and spread back into the bladder, causing another UTI. Indeed, this study by researchers from Washington University School of Medicine in St. Louis and the Broad Institute of MIT and Harvard suggests that women who suffer from recurrent UTIs could be caught in a vicious circle in which antibiotics given to eradicate one infection predispose them to developing another.

Urinary tract infections: less diverse microbiomes

To reach these conclusions, the researchers studied 15 women with a history of urinary tract infections recurrent and 16 women having none. All participants provided urine and blood samples at the start of the study and monthly stool samples. The team analyzed the bacterial composition of stool samples, tested for the presence of bacteria in urine, and measured gene expression in blood samples. As a result, the scientists observed that the women with recurrent urinary tract infections who participated in the study had less diverse microbiomesdeficient in an important group of bacteria that help regulate inflammation, and a distinct immunological signature in their blood indicative of inflammation.

Patients with repeated infections had lower diversity of healthy gut microbial species, which could give more opportunities for pathogenic species to establish themselves and multiply. In particular, the researchers found that the microbiomes of women with recurrent UTIs were particularly low in bacteria that produce butyrate, a short-chain fatty acid with anti-inflammatory effects.

Antibiotics: why they promote recurrences

“We believe that women in the control group were able to clear bacteria from their bladders before they caused illness, whereas women with recurrent UTIs were unable to do so, due to a different immune response to bacterial invasion of the bladderpotentially linked by the gut microbiome,” said Colin Worby, biologist and lead author of the study.

The results of this study highlight the importance of finding alternatives to antibiotics to treat urinary tract infections. “Our study clearly demonstrates that antibiotics do not prevent future infections or eliminate the strains responsible for UTIs in the gut. They may even promote recurrences of UTIs by keeping the microbiome in a disrupted state,” says the main author.

Chronic urinary tract infections: bowel and bladder connected

“It is frustrating for women who see a doctor for a recurring infection to see the doctor, who is usually a man, giving them hygiene advice. That’s not necessarily the problem. It is not necessarily poor hygiene that is the cause. The problem lies in the disease itself, in this gut-bladder connection and inflammation levels. In fact, doctors don’t know what to do with recurring UTIs. All they have are antibiotics, so they add more, which probably only makes it worse”, concludes Scott J. Hultgren, co-author of the study and professor of molecular microbiology at the University of Washington.

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