The challenge of urinary tract infections

Urinary tract infection can be defined as bacterial invasion of the urinary tract leading to an inflammatory response. This means that in order to speak of infection there must be a defensive reaction of the organism, which is manifested by the presence of leukocytes or white cells in the urine. Thus, if there are no leukocytes in the urine, no matter how many germs there are, there is no infection. This fact, often not well known, that a urine can have thousands of colonies of germs without there necessarily being an infection, means that antibiotics are very often used unnecessarily. In addition, other diseases give symptoms similar to those of urinary tract infection such as a ureter stone, gynecological diseases, pain of psychosomatic cause that settle in that area and what is more serious, sometimes a bladder cancer simulates a cystitis, which is poorly treated with antibiotics, which delays the diagnosis and darkens the prognosis.

Another problem with the misuse of antibiotics is that they tend to destroy all the bacteria that live with us and protect us, leaving the way open for the invasion of the so-called opportunistic germs leading to genital fungal infections, often serious. In addition, in the digestive tract they can destroy all the bacteria that help us digest, leaving the door open to virulent germs, such as the dreaded Clostridium difficile, which thrive in the intestine when all competing bacteria have been killed off (Fig. 1).

Clostridium difficile that thrives in the intestine after the use of antibiotics.

To all this must be added the serious problem of self-medication, because in many countries antibiotics are still sold without prescription and without any kind of control, which constitutes a “breeding ground” for the emergence of resistance. Bacterial resistance is a natural evolutionary process by which microorganisms adapt to the selective pressure of drugs, so that the survivors have genetic material that makes them practically indestructible.

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Bacterial resistance is becoming a public health drama in the world, as we live in an era in which the risk of suffering a serious infection is similar to that of the 1930s. In fact there are more than 8000 Europeans who die every year due to the ineffectiveness of current antibiotics and curiously urinary tract infections are largely responsible for this serious epidemic, because among other things it is the most frequent infection acquired in a hospital.

In addition, the number of new antibiotics coming onto the market is scarce compared to what happened in previous decades, i.e. there is a disproportion between the number of multiresistant germs and the creation of new antibiotics, which further aggravates the situation, because it is also unlikely that this trend will change in the immediate future.

For all these reasons, society should be educated to avoid self-medication at all costs, and medical professionals should be educated not to treat urinary tract infections indiscriminately and to limit the use of antibiotics as much as possible. Because doctors, understandably, have an obligation to act and not stand idly by, but evidence shows that, in the case of infections, it is often preferable to do nothing so as not to mistreat the patient.