A urinary tract infection (UTI) is a bacterial (or sometimes fungal infection) in the bladder, and urethra of the urinary system and less often in the ureters and kidneys. UTIs are most common in residents of long-term care facilities such as nursing homes.
A recent study has found, “Delaying or withholding antibiotics in patients aged over 65 with symptoms of urinary tract infection seems to be associated with a higher risk of sepsis and death.” Those over 85, especially men were more at risk.
Urosepsis is a condition where a urinary tract infection spreads from the urinary tract to the bloodstream, causing a systemic infection (sepsis) that circulates through the body. It is estimated 25% of individuals who develop sepsis started as a urinary tract infection. Each year, about 90,000 people in the United States die from septic shock.
The elderly population account for 65% of sepsis cases and people over 65 are 13 times more likely to have sepsis than younger people.
Urosepsis is very serious and can quickly progress to a life-threatening infection as it can develop into an infection that is difficult to control with medication. In the most severe cases, sepsis can lead to multi-system organ failure and death.
Many elderly patients are not being treated for chronic UTIs because of antibiotic resistance and potential development of the deadly infection C-diff.
Dr, Bradley W. Frazee, MD, from Alameda Health System Highland Hospital, Oakland, California states, “Urinary tract infections caused by multidrug-resistant bacteria pose a serious threat to public health and the economy.”
Geriatrician Dr. Amanda Lathia, M.D says, “If you treat asymptomatic bacteriuria with antibiotics, there’s a good chance that the bacteria in the urine will become resistant to antibiotics, making it challenging to treat a symptomatic UTI in the future.”
Reported in the March 1, 2019 journal Antimicrobial Chemotherapy “Elderly people in nursing homes had a risk around 40% higher than their community-dwelling peers of having antibiotic-resistant Enterobacteriaceae cultured from their urine samples.”
Now a study published in the February 2, 2019 British Medical Journal has found elderly patients with a diagnosis of UTI in primary care, who were not given antibiotics or deferred antibiotics were associated with a significant increase in bloodstream infection.
The researchers discovered mild illness to severe sepsis, with a mortality rate of 20-40%. “The incidence of sepsis and its associated mortality increases disproportionately with age, and UTI in men is more likely to be severe.”
The study concluded, “As the pattern of antibiotic use changes in the context of antimicrobial resistance, it is now more important than ever to assess the management and outcome of UTIs. Clostridium difficile (C.Diff ) in elderly people has also been one of the drivers for scrutiny of unnecessary antibiotic use in this population. A decline in antibiotic use may, however, harm vulnerable older populations who are already more likely to develop UTI related complications and bloodstream infection.”
More than 60% of sepsis diagnoses are made in adults aged 65 years.
This is a huge dilemma for the medical industry, whether to treat or withhold antibiotics for older patients with chronic urinary tract infections.
Understanding why older individuals often develop UTI’s is important.
Dehydration- Many elderly persons do not drink enough water, because they do not want to urinate as often. Also many are taking diuretics or other medications that causes dehydration. Older individuals must drink plenty of fluids to flush the bacteria from their systems. Proper fluid intake makes it harder for bacteria to live and multiply in the urinary tract. It is recommended older adults drink four to six 8-ounce glasses of water a day.
Incontinence – Urinary incontinence is a common problem among the elderly and may be a risk factor for UTIs. As urine leaks out of the bladder, it can provide an environment for bacteria to grow and then travel up into the urinary tract. This can be enhanced by protective pads that absorb the urine and breed bacteria.
Not wiping from front to back. Bacteria tend to hang around the anus. If you wipe from front to back, especially after a bowel movement, they're less likely to make it to the urethra.
Hormones – In women, menopause leads to a slowed production of estrogen. Estrogen has been shown to protect the vagina and urethra from bacterial growth. As production decreases, E. coli and other bacteria may be able to more easily establish themselves. Natural hormone balancing can help.
Mobility – Often elderly individuals have decreased stability and or mobility and find bathing or showering difficult leading to increased UTI risk. Those who are confined to a wheelchair or bedridden, are not able to stand up for kidneys and bladder to drain totally which trap bacteria in the urinary system.
Dementia – Having dementia or Alzheimer’s disease can decrease one’s ability to communicate symptoms and can also make maintaining good general hygiene more difficult as extra care is required.
Diabetes – Diabetes can decrease one’s immune system, making it more difficult to fight an infection. In addition, diabetes can lead to nerve damage. Nerve damage in the bladder can decrease bladder control and increase incontinence. If poorly managed, those with diabetes can have high amounts of sugar in the urine, which bacteria can eat to grow.
Catheter use – For various reasons, it may be necessary to have chronic or occasional catheter use in older adults. If so, this is a major risk factor for UTI’s, as new bacteria can be introduced and allow bacteria to establish protective biofilms on the indwelling catheters.
Fortunately, there are many supplements that can help prevent and eliminate urinary tract infections.
Cranberry Extract: According to a 2012 review of studies for Cranberry extract, found it helps prevent UTI’s in women especially those with recurrent infections. I have found this to be true for most of my patients (with the exception of those with cystitis. Published in the June 2013 issue of the Canadian Journal of Microbiology, researchers found high concentrations of cranberry dramatically decreased E. Coli’s ability to swim and swarm and appeared to disrupt the bacteria's production of the urease accessory gene, which affects how virulent the bacteria can become. Because cranberry only disables bacteria, the bacteria are not given the chance to grow stronger as they resist antibiotic intervention. Eventually, the disabled bacteria are simply flushed out of the body.
D-Mannose is a natural sugar which attaches to E. coli bacteria, causing them to stick to each other and preventing them from sticking to the walls of the urinary tract / bladder walls. The bacteria can then easily be eliminated from the body during urination. D-mannose is not metabolized the way other sugars are, making it safe for diabetics and others who are avoiding sugar for any reason. Take 500mg 2-3 x day.
Uri-Active (Lifetime Vitamins) is a convenient & effective combination formula contains: cranberry, d-mannose & astragalus to decrease infection, dandelion & buchu to strengthen bladder muscles and to empty bladder better. With infection take 3 caps 3 x day for 4 days. For prevention continue to take 1 cap, 1 or 2x a day daily.
Natural Golden Salve (Barlow Herbals) a natural antibacterial salve containing lomatium. Proper cleaning of the urethra and genital area (pericare), is important after each incontinence episode or bathroom use. After cleansing apply a small amount of natural golden salve topically to kill off any remaining external bacteria that could find their way into the bladder.
Sometimes a little extra help is needed.
Oregano oil is a powerful natural antibacterial essential oil because it contains carvacrol and thymol, two antibacterial and antifungal compounds. A 2012 research study from Poland shows oregano oil is effective against many clinical strains of bacteria, including Escherichia coli (E. coli) and Pseudomonas aeruginosa. Take as directed on the label.
Urinary tract infections need not be deadly. Prevention in the first place is where the focus needs to be.
As always check with your health practitioner before utilizing natural remedies to make sure they are appropriate for your health concerns.
Jane Jansen Holistic Practitioner
Tree of Life Wellness Center Seekonk, MA 02771 508-336-4242
Host Holistic Healthline Radio