Image courtesy of the CDC
Many of you know that I work in a hospital as an Infection Preventionist in Fabulous Las Vegas. In that capacity, I see a lot of lab results. Recently, there has been a notable number of cases of urine cultures growing germs with an interesting pattern of multi-drug antibacterial resistance. The strangest part is how many of these samples did not come from our very ill inpatient populations. No, they are coming from our walk in patients in the Emergency Department.
Now make no mistake: I am aware that the plural of anecdotes is not data. However, we are certainly in a “huh, that’s funny” place with this.
It’s called Extended Spectrum Beta Lactamase producing bacteria, ESBL for short. To explain what that means, I’m going to step back and somewhat oversimplify things.
Bacteria are very simple single cell organisms. They have a cell wall instead of the cell membrane you and I have around our cell. That cell wall is made up of big molecules just like the walls in your house might be made of studs, drywall, and nails. Beta lactam antibiotics like penicillin work by pulling the bacterial “nails” so the cell wall can’t be built. This prevents baby bacteria from being made and fairly quickly results in the existing bacteria dying off.
Chemists provide clues for what things do when they name things. When you see something that ends with –ase, it neutralizes something. You take lactase so you can comsume lactose, for example. So Beta lactamase neutralizes those Beta lactam antibiotics. No chemical nail puller? Cell wall construction is back on!
The ESBL germs that I am seeing are also often resistant to other drugs like Cipro and Macrobid. While Cipro is the “old” front line UTI drug, Macrobid is considered the newer, better alternative.
So then, what do my ESBL urine cultures have to do with you? It means your UTI might have hard-to-kill germs. The drugs your doctor orders without a second thought may not kill the germs. Worse yet, you might think they’re working only to find your symptoms returning a month later — which is what I am convinced happened to the woman whose advertising claims she developed her product after “7 UTIs in one year!!”
My advice to anyone who believes they are having a UTI is to respectfully insist on a culture to make sure the drugs you are prescribed actually kill the germs that are present.