Saturday, September 28, 2019

Antibiotic resistance: UTI, among top 10 causes of death in Singapore, trickier to treat - CNA

Antibiotic resistance: UTI, among top 10 causes of death in Singapore, trickier to treat - CNA

Antibiotic resistance: UTI, among top 10 causes of death in Singapore, trickier to treat

Pee holding urinary tract infection antibiotics
(Photo: Pixabay)
(Updated: )


SINGAPORE: By all accounts, Sharon's (not her real name) surgery to remove fibroids earlier this year was a success. 

The 32-year-old was discharged armed with information that urinary tract infection (UTI) was a risk from the surgery.

She found out during a follow-up visit a week later that she did contract UTI – an infection most commonly caused by E. Coli bacteria. As is typical for the infection, Sharon was prescribed antibiotics.

When it looked like she was not recovering, Sharon was prescribed another course of antibiotics.

"I still didn't get better. I bore with it and went for a follow-up appointment for my surgery," the civil servant told CNA.

READ: A health issue for the future? Pharmaceutical Society of Singapore raises alarm on antibiotic resistance

It was then that doctors discovered that the infection had spread to her kidneys. This could have serious consequences including permanent kidney damage if not treated. Tests done by the doctors showed that the antibiotics she took were ineffective to treat her UTI. The bacteria in her body was resistant to the antibiotic.

She was immediately warded, and given antibiotics intravenously, which had a higher chance of curing the infection.

Sharon recovered, but doctors have warned her that she would need to be hospitalised if she gets another bacterial infection.


Doctors told CNA that cases of UTI which do not get cured with the usual antibiotics are becoming more common.

Associate consultant in the Department of Urology at the National University Hospital Dr Melissa Tay said she sees at least five patients with recurrent or complicated cases a week at her clinic, more than she used to. Half of them are new referrals, she added.

"In addition, there is also an increasing number of inpatient referrals for the management of complicated urinary tract infections," she said. 

Her peers observed similar trends.

Dr Christopher Chong, urogynaecologist at Gleneagles Hospital, also said that it is "fairly common these days" to see patients who are not cured by the usual antibiotics, pointing to antibiotic resistance.

READ: Having a runny nose? Avoid antibiotics, or we could pay a deadly price

READ: Women who drink more water get fewer UTIs

The growing problem of antibiotic resistance in UTI is seen in other countries as well. 

Research by the New York City Department of Health in the United States showed that a third of uncomplicated UTI cases were resistant to Bactrim, one of the most widely used drugs, and at least one-fifth of them were resistant to five other common treatments. 

Medical journal The Lancet provides similarly bleak statistics. Research it published last year showed that more than a third of all UTIs caused by E. Coli in Britain were resistant to "key antibiotics".

A recent Singapore study in three polyclinics also concluded that more than 20 per cent of UTI cases were resistant to antibiotics prescribed to them.

"Patients who take many courses of antibiotics are more likely to develop resistant bacterial strains," said Dr Valerie Gan, consultant in the Department of Urology at the Singapore General Hospital.

Those who have been hospitalised frequently for other medical problems could also develop resistance as they are exposed to more resistant strains of bacteria, she added.


While Sharon recovered from her UTI infection, others are not so lucky. According to the Ministry of Health's list of principal causes of death here, UTI ranked eighth, higher than chronic obstructive lung diseases and type 2 diabetes.

The numbers showed that 2 per cent of total deaths were caused by UTI each year - more than 400 people. 

Researchers warn that overuse of antibiotics could cause resistance to spiral out of control, to an
Researchers warn that overuse of antibiotics could cause resistance to spiral out of control, to an "unknown tipping point" when the drugs are no longer effective. (Photo: AFP/Jorge Drikx)

According to HealthHub, in Singapore, about 4 per cent of young adult females have contracted UTI. The incidence rises with age to 7 per cent at 50 years.

READ: Is it okay to hold your pee when you don't have the time or can't find a toilet?

Dr Chong said that to deal with antibiotic resistance, he does a detailed urine culture test that takes three days to produce results.

"If a bacterium is found, then this bacterium is 'matched' with a list of antibiotics to see which one the bacterium is sensitive to and can and should be used to treat," he said.

In some cases, when there is resistance against all oral antibiotics, the patient may have to be hospitalised so that intravenous antibiotics can be administered, he added.


But UTI is not the only bacterial infection becoming resistant to antibiotics, said the Pharmaceutical Society of Singapore (PSS).

It highlighted pneumonia as another disease which has developed resistance to antibiotic treatment, and now typically requires higher doses of antibiotics. 

The PSS also pointed to skin infections, which are commonly caused by bacteria that have been resistant to antibiotics for a long time.

It pointed to the US' Centers for Disease Control and Prevention numbers that showed at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die as a result, to highlight the seriousness of the issue.

"Antibiotic resistance isn't just a hypothetical concept, but its impact is already being seen today and is causing significant morbidity and mortality," PSS said.

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