tag:theconversation.com,2011:/fr/topics/urinary-tract-infection-29907/articlesUrinary Tract Infection – The Conversation2024-03-20T00:08:53Ztag:theconversation.com,2011:article/2249622024-03-20T00:08:53Z2024-03-20T00:08:53ZNow you can get UTI antibiotics from pharmacies without prescription. Here’s what to know<figure><img src="https://images.theconversation.com/files/581151/original/file-20240312-29-6jfwhi.jpg?ixlib=rb-1.1.0&rect=18%2C37%2C6164%2C4078&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-giving-medicine-box-customer-pharmacy-1785830159">Shutterstock</a></span></figcaption></figure><p>Urinary tract infections can be a minor medical annoyance or lead to a hospital stay – especially for older people.</p>
<p>If you think you might have a urinary tract infection (UTI) you need prompt advice and often antibiotics. But it can be <a href="https://www.abc.net.au/news/2023-06-21/urgent-gp-appointments-difficult-to-get-in-regional-rural-areas/102496354">difficult to get an appointment</a> with your doctor at short notice, especially in rural areas. </p>
<p>Now trained <a href="https://www.guild.org.au/guild-branches/wa/business-support/uti">pharmacists</a> in most Australian states are able to review your symptoms and supply antibiotics if appropriate. </p>
<p>But there are still times when you should see a doctor.</p>
<h2>What is a UTI? And when is it serious?</h2>
<p>The <a href="https://training.seer.cancer.gov/anatomy/urinary/components/">urinary tract</a> consists of the kidneys, ureters, and bladder and urethra. It’s the body system responsible for producing, storing and removing urine from the body. </p>
<p>When bacteria invade the urinary system – mostly from the bowel or the skin – they can multiply and cause infection. </p>
<p>Roughly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">half of all women</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">one in 20 men</a> will have a UTI at least once in their lifetime. The risk increases with age. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502976/">One in ten</a> postmenopausal women report having a UTI in the last year.</p>
<p>Typical signs of infection include a painful or burning sensation when urinating, feeling like you need to urinate urgently and often and cloudy or foul-smelling urine. In more severe cases symptoms can include fever, lethargy and pain in the lower back. </p>
<p>In older adults, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9827929/#:%7E:text=Delirium%20is%20a%20common%20atypical,and%20complex%20relationship%20between%20them.">UTIs can cause confusion, agitation and falls</a>.</p>
<p>For some people, UTIs can have <a href="https://www.ncbi.nlm.nih.gov/books/NBK482344/">serious complications</a>, such as kidney damage, kidney failure or infection in the blood (sepsis), particularly if treatment is delayed. </p>
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Read more:
<a href="https://theconversation.com/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?</a>
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<h2>A common reason for hospital admission</h2>
<p>UTIs are the <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">second most common</a> cause of preventable hospital visits in Australia. Across the country they are <a href="https://outbreakproject.com.au/2020/11/17/australias-multi-billion-dollar-superbug-crisis/">reported</a> to result in 100,000 emergency department visits and 75,000 hospital stays each year. </p>
<p>The rate of hospitalisation for UTIs for Aboriginal and Torres Strait Islander people is around <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">double</a> the rate for other Australians. People aged over 65 years are <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/24-kidney-infections-and-urinary-tract-infections">five times</a> more likely to be hospitalised with a UTI than younger Australians.</p>
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<a href="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman sits on couch and shows pained expression, clutches lower stomach" src="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581162/original/file-20240312-26-vuano6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Older people are much more likely to be hospitalised with a UTI.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-elderly-senior-woman-stomach-ache-2391031945">Shutterstock</a></span>
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<h2>A quicker option</h2>
<p>The newly rolled out pharmacist consultations do not replace the option of visiting your GP. But they do provide an additional choice.</p>
<p>In <a href="https://statements.qld.gov.au/statements/95679">Queensland</a>, <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/sa+community+pharmacy+uti+services/sa+community+pharmacy+uti+services#:%7E:text=From%201%20March%202024%2C%20eligible,a%20prescription%20from%20a%20doctor.">South Australia</a> and <a href="https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists">Western Australia</a> the legislation has been changed to allow pharmacists to supply antibiotics to treat women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs.</p>
<p>In <a href="https://www.health.nsw.gov.au/pharmaceutical/Pages/pharmacy-trial-uti.aspx">New South Wales</a>, the <a href="https://www.health.act.gov.au/health-professionals/pharmaceutical-services/act-pharmacy-uti-and-oral-contraceptive-pill-trial">ACT</a>, <a href="https://www.premier.vic.gov.au/pharmacists-delivering-accessible-health-care-victorians">Victoria</a> and <a href="https://www.health.tas.gov.au/pharmacyscope">Tasmania</a> trials allowing pharmacists to treat UTIs in the same patient group are underway or have been announced.</p>
<p>This approach to provide accessible and timely treatment options for UTIs through pharmacies aligns with that in <a href="https://www.psnz.org.nz/healthservices/utis">New Zealand</a>, the <a href="https://www.england.nhs.uk/long-read/launch-of-nhs-pharmacy-first-advanced-service/">United Kingdom</a> and <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwibvafH0OOEAxV4plYBHU9RBeEQFnoECBsQAQ&url=https%3A%2F%2Fwww.pharmacists.ca%2Fcpha-ca%2Fassets%2FFile%2Feducation-practice-resources%2FUncomplicated_UTI.pdf&usg=AOvVaw1E6EnFunmJRdVF8wD_AxuN&opi=89978449">Canada</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">Cranberry juice can prevent recurrent UTIs, but only for some people</a>
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<h2>Not for everyone</h2>
<p>State guidelines direct pharmacists to only provide antibiotics to women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs. If the pharmacist finds warning signs for a serious infection, or a complicated UTI, you will be referred for further consultation with a doctor. </p>
<p>Under this program, UTIs that occur in people who have an anatomically male urinary tract, are under 18 years or over 65, or are pregnant would be considered to have complicated UTIs, and such patients would be referred to their doctor.</p>
<p>Some other situations where UTIs are considered <a href="https://www.health.wa.gov.au/Articles/S_T/Treatment-of-urinary-tract-infection-by-pharmacists">complicated</a> and should be assessed by a doctor include when they occur in people with kidney disease, urinary catheters, a condition that weakens the immune system (such as diabetes, cancer or HIV) or reoccurring symptoms. </p>
<p>To supply antibiotics for UTI treatment pharmacists are required to undertake additional training. Pharmacists can only prescribe antibiotics according to an agreed evidence-based treatment guideline, <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/b52bbef1-4fed-4502-96ed-3ebf97ebdee1/Community+Pharmacy+UTI+Service+SA+Management+Protocol+-+Final1.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-b52bbef1-4fed-4502-96ed-3ebf97ebdee1-oRYPyBR">such as South Australia’s</a>. </p>
<p>Pharmacists will assess if you are eligible for the pharmacy UTI service and ask specific questions to check your symptoms match those of an uncomplicated UTI or for warning signs you need to see a doctor. If treatment is appropriate, they will ask questions about your medical and medication history to determine which type of antibiotic is most suitable for you.</p>
<p>Pharmacists will not test urine for bacteria, as Australian guidelines state antibiotic treatment <a href="https://tgldcdp.tg.org.au/searchAction?appendedinputbuttons=UTI">can be started</a> for women with uncomplicated UTIs straight away. If your symptoms or history suggest urine testing might be required the pharmacist will refer you to a doctor. </p>
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<a href="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical clinicians holds urine test and indicator" src="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581161/original/file-20240312-22-r54i0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pharmacists won’t test urine samples.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-doing-test-strip-labstix-urine-1493181821">Shutterstock</a></span>
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<p>You can get a record of the consultation that you can share with your doctor. The requirements for documentation differ in different states but pharmacists can upload information to <a href="https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record">My Health Record</a> (if you haven’t opted out and are happy for them to do so).</p>
<p>This new service is not without <a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">controversy</a>. GPs have expressed concerns about misdiagnosis and <a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">antimicrobial resistance</a> where the bacteria could evolve and become much harder to treat. Detailed procedures have been developed for pharmacists to minimise these risks. </p>
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Read more:
<a href="https://theconversation.com/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria</a>
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<h2>What else can you do?</h2>
<p>While taking antibiotics to <a href="https://www.healthdirect.gov.au/urinary-tract-infection-uti">treat a UTI</a> you should also <a href="https://www.continence.org.au/urinary-tract-infection-uti">drink lots of water</a> and ensure you empty your bladder completely every time you go to the toilet.</p>
<p>Pain relievers can help ease discomfort from a UTI. But it’s important to speak with your pharmacist or doctor to find the best pain management option for you.</p><img src="https://counter.theconversation.com/content/224962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta L. Johnson is employed as the Senior Pharmacist for Research within SA Pharmacy and is a Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation – Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, the Australian College of Pharmacy, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd. Jacinta has not received funding from any organisation related to pharmacist consultations for provision of antibiotics for urinary tract infections.</span></em></p><p class="fine-print"><em><span>Wern Chai does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older people and Aboriginal and Torres Strait Islander people are at much greater risk of hospitalisation from UTI. Prompt medical care is important.Jacinta L. Johnson, Senior Lecturer in Pharmacy Practice, University of South AustraliaWern Chai, Lecturer in Pharmacy and Pharmacology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230082024-02-21T03:45:57Z2024-02-21T03:45:57ZWhy do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?<figure><img src="https://images.theconversation.com/files/576612/original/file-20240219-26-qkb5eg.jpg?ixlib=rb-1.1.0&rect=209%2C473%2C7139%2C4429&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-tired-young-tattooed-business-woman-1703410366">BAZA Productions/Shutterstock</a></span></figcaption></figure><p>Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.</p>
<p>UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom. </p>
<p>Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.</p>
<p>They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.</p>
<p>Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.</p>
<h2>Why are chronic UTIs so hard to treat?</h2>
<p>Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach. </p>
<p>The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments. </p>
<p>This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective.</p>
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Read more:
<a href="https://theconversation.com/how-do-bacteria-actually-become-resistant-to-antibiotics-213451">How do bacteria actually become resistant to antibiotics?</a>
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<img alt="Underpants hanging on a clothesline" src="https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some antibiotics no longer work against UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womens-underwear-hangs-on-clothesline-687500683">Michael Ebardt/Shutterstock</a></span>
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<p>Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted. </p>
<p>But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.</p>
<p>Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria. </p>
<p>Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions. </p>
<p>The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence. </p>
<p>For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.</p>
<p>Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role. </p>
<p>Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>.</p>
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Read more:
<a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">Cranberry juice can prevent recurrent UTIs, but only for some people</a>
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<h2>What treatments might we see in the future?</h2>
<p>Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu. </p>
<figure class="align-center ">
<img alt="Gynaecologist talks to patient" src="https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Emerging treatments could help clear chronic UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gynecologist-talks-patient-during-medical-consultation-2298674535">guys_who_shoot/Shutterstock</a></span>
</figcaption>
</figure>
<p>Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus. </p>
<p>Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves. </p>
<p>Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.</p>
<p>Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phage-therapy-could-treat-some-drug-resistant-superbug-infections-but-comes-with-unique-challenges-207025">'Phage therapy' could treat some drug-resistant superbug infections, but comes with unique challenges</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Iris Lim does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Chronic UTIs come back repeatedly or never fully go away despite treatment.Iris Lim, Assistant Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116752023-11-21T23:30:20Z2023-11-21T23:30:20ZHere’s what happens to your penis as you age<figure><img src="https://images.theconversation.com/files/558209/original/file-20231108-29-2x75fz.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-stethoscope-yellow-banana-on-blue-1070813387">Shutterstock</a></span></figcaption></figure><p>All parts of your body age and the penis is no exception. </p>
<p>Changes to how your penis looks or works can be signs of underlying health issues and can affect your quality of life. So understanding which changes are normal and when to seek help is important.</p>
<p>Here’s what you can expect to happen to your penis as you age, and when to be concerned.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-clean-my-penis-125135">'How do I clean my penis?'</a>
</strong>
</em>
</p>
<hr>
<h2>Will my penis shrink?</h2>
<p>There is no definitive evidence your <a href="https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/bju.13010">penis length and girth</a> will naturally change as you age, despite what you may <a href="https://www.healthline.com/health/mens-health/penis-shrinkage">read</a>.</p>
<p>This is because there is no study that follows the same adults and their penis measurements over decades; existing studies only compare penis size between different adults of different ages. </p>
<p>There are also many different ways to <a href="https://www.nature.com/articles/s41443-019-0157-4">measure</a> penis size – including stretched, flaccid (floppy) and erect. This makes it difficult to compare studies.</p>
<p>However, for some people, conditions associated with ageing can appear to decrease penis length. These include:</p>
<ul>
<li><p>obesity (which hides the base of the penis)</p></li>
<li><p>the effects of <a href="https://www.auajournals.org/doi/10.1016/j.juro.2007.03.119">prostate surgery</a> (temporarily)</p></li>
<li><p><a href="https://www.healthymale.org.au/mens-health/peyronies-disease">Peyronie’s disease</a> (where scarring in the fibrous layer of the penis causes it to bend abnormally).</p></li>
</ul>
<p>Erect penis length may also decrease with age due to:</p>
<ul>
<li><p>erectile dysfunction (the inability to achieve erections sufficient for sexual activity)</p></li>
<li><p>less <a href="https://pubmed.ncbi.nlm.nih.gov/1459150/">penile elasticity</a>, which reduces how much the penis expands.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-chemicals-shrinking-your-penis-and-depleting-your-sperm-heres-what-the-evidence-really-says-160007">Are chemicals shrinking your penis and depleting your sperm? Here's what the evidence really says</a>
</strong>
</em>
</p>
<hr>
<h2>Will I still have erections?</h2>
<p>Erectile dysfunction affects 15% of men in their 50s to almost 90% of men over 80, according to an <a href="https://link.springer.com/article/10.1007/s10508-014-0465-1">English study</a> of more than 6,000 people. Existing health conditions increased the risk significantly, and the risk was more than doubled in those who rated their health as fair to poor.</p>
<p><a href="https://www.healthymale.org.au/mens-health/erectile-dysfunction">Medications</a> such as sildenafil (Viagra) and tadalafil (Cialis) can help. But they do not reverse the underlying blood vessel and nerve damage that cause erectile dysfunction. Eventually other treatments – such as injections or <a href="https://www.healthymale.org.au/news/what-are-penis-pumps-and-how-do-they-work">penile pumps</a> – may be options.</p>
<p>Other changes that occur with age include <a href="https://pubmed.ncbi.nlm.nih.gov/9836563/">decreased penis sensitivity</a>, which might reduce arousal. Ejaculation is <a href="https://pubmed.ncbi.nlm.nih.gov/8254833/">delayed</a> and happens <a href="https://linkinghub.elsevier.com/retrieve/pii/S0302283816003778">less often</a>.</p>
<p>Semen volume and the force of ejaculation <a href="https://pubmed.ncbi.nlm.nih.gov/27652226/">decrease</a> with age. The time taken to “recover” from ejaculating and become sexually responsive again (known as the <a href="https://pubmed.ncbi.nlm.nih.gov/31405769/">post-ejaculatory refractory time</a>) also increases with age. </p>
<p>Reaching orgasm is “impossible” or “moderately difficult” for <a href="https://pubmed.ncbi.nlm.nih.gov/25624001/">33% of men</a> in their 70s.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-the-hard-facts-on-viagra-58289">Weekly dose: the hard facts on Viagra</a>
</strong>
</em>
</p>
<hr>
<h2>Will the shape of my penis change?</h2>
<p>The shape of your penis is not usually expected to change with age. However, Peyronie’s disease (an abnormally bent or curved penis) becomes <a href="https://www.healthymale.org.au/mens-health/peyronies-disease">more common</a> with age. This may be because of accumulation of damage from minor injuries over time.</p>
<p>This condition affects <a href="https://pubmed.ncbi.nlm.nih.gov/11890244/">6.5% of men</a> over 70 and can cause short-term pain and long-term erectile dysfunction.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older smiling man holding banana in each hand, one large, one small" src="https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No, your penis doesn’t automatically change shape as you age. But you might notice other changes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-country-doctor-smiling-while-comparing-758197381">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Will I pee more?</h2>
<p><a href="https://www.healthymale.org.au/mens-health/urinary-problems-luts">Lower urinary tract symptoms</a> such as incontinence, a weak urine stream, problems with starting and stopping peeing, and nocturia (frequent night time urination) increase as we get older. </p>
<p>These symptoms are moderate to severe in <a href="https://pubmed.ncbi.nlm.nih.gov/17070357/">almost 50% of men</a> over 65, and in <a href="https://pubmed.ncbi.nlm.nih.gov/18554695/">70% of men</a> over 80. This is likely due to <a href="https://pubmed.ncbi.nlm.nih.gov/6206240/">higher rates</a> of benign prostatic hyperplasia (enlarged prostate) as men age, which has various effects, including on urine flow.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-can-your-doctor-tell-from-your-urine-74990">Health Check: what can your doctor tell from your urine?</a>
</strong>
</em>
</p>
<hr>
<h2>Changes can take their toll …</h2>
<p>Physical and functional changes in the penis can affect a man’s <a href="https://pubmed.ncbi.nlm.nih.gov/25624001/">health and wellbeing</a>. </p>
<p>Problems with erections or ejaculating can reduce someone’s <a href="https://pubmed.ncbi.nlm.nih.gov/30554952/">quality of life</a> if they still want to have sex. So <a href="https://www.healthymale.org.au/partners-guide">open discussion</a> with a partner, seeking support and professional advice can help.</p>
<p>Lower urinary tract symptoms can also <a href="https://pubmed.ncbi.nlm.nih.gov/15814179/">affect</a> a man’s mental health and personal relationships. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older gay couple sitting on sofa, one with hand on shoulder, looking at open laptop" src="https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Be open with your partner about any concerns.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/older-same-sex-male-couple-browsing-2356931529">Shutterstock</a></span>
</figcaption>
</figure>
<h2>… but can be sign of disease</h2>
<p>Erectile dysfunction can also hint at serious health problems <a href="https://www.healthymale.org.au/mens-health/erectile-dysfunction">such as</a> heart disease, high blood pressure, diabetes and disorders of the nervous system.</p>
<p>In this way, the penis reflects vascular health in the rest of the body. So having erectile dysfunction can <a href="https://pubmed.ncbi.nlm.nih.gov/30665816/">predict</a> your risk of a future heart attack or stroke.</p>
<p>Lower urinary tract symptoms are also often associated with sexual dysfunction, and can <a href="https://www.healthymale.org.au/mens-health/urinary-problems-luts">increase the risk</a> of urinary tract infections and chronic kidney disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-it-matter-if-you-sit-or-stand-to-pee-and-what-about-peeing-in-the-shower-206869">Does it matter if you sit or stand to pee? And what about peeing in the shower?</a>
</strong>
</em>
</p>
<hr>
<h2>What’s normal and when should I see my GP?</h2>
<p>Normal ageing includes changes to the penis’ blood vessels, nerves, and associated organs, such as the prostate. So, as you age, it is normal to have:</p>
<ul>
<li><p>minor changes in the size and shape of the penis</p></li>
<li><p>a gradual decrease in erectile function and sensitivity</p></li>
<li><p>mild urinary symptoms that don’t bother you.</p></li>
</ul>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28217447/">Staying healthy</a>
and regularly seeing your GP to <a href="https://www.healthdirect.gov.au/essential-screening-tests-for-men">check for</a> common conditions (such as high blood pressure) should slow down these age-related changes. Other health conditions (such as diabetes) accelerate these changes.</p>
<p>However, it is important to seek medical attention if:</p>
<ul>
<li><p>there is a significant change in size or shape of the penis, or if you develop unusual lumps</p></li>
<li><p>there is pain or discomfort in or around your penis</p></li>
<li><p>erectile dysfunction becomes persistent or bothers you</p></li>
<li><p>urinary symptoms occur suddenly or bother you.</p></li>
</ul>
<hr>
<p><em>For more information about men’s health, including resources for partners, see the <a href="https://www.healthymale.org.au">Healthy Male website</a>.</em></p><img src="https://counter.theconversation.com/content/211675/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Moss works for Healthy Male, a website to promote men's health.</span></em></p><p class="fine-print"><em><span>Jinghang Luo and Rob McLachlan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Understanding which changes are normal and when to seek help is important. Here’s what you need to know.Rob McLachlan, Professor and clinician in fertility medicine, Hudson InstituteJinghang Luo, Andrology Fellow, Hudson InstituteTim Moss, Adjunct Associate Professor, Department of Obstetrics and Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2039262023-04-19T08:00:21Z2023-04-19T08:00:21ZCranberry juice can prevent recurrent UTIs, but only for some people<figure><img src="https://images.theconversation.com/files/521741/original/file-20230419-24-kc6toy.jpg?ixlib=rb-1.1.0&rect=170%2C131%2C4966%2C3313&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sweet-red-water-glass-juice-nectar-706221325">Shutterstock</a></span></figcaption></figure><p>Many of us know cranberries as a tasty condiment to have with our Christmas turkey, or the juice that accompanies vodka in a cosmopolitan cocktail. You might have also heard cranberries <a href="https://www.phc.ox.ac.uk/news/blog/cranberry-for-acute-urinary-tract-infection-2013-an-old-wives2019-tale-or-mother-nature2019s-cure-1">prevent urinary tract infections</a> (UTIs).</p>
<p>While this is often dismissed as a myth, our <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001321.pub6/full">new review of the evidence</a> shows consuming cranberry juice or supplements reduces the chance of repeat UTIs for women, children, and those who are more susceptible to them due to medical procedures. </p>
<p>But this wasn’t the case for elderly people, pregnant women, or for people with bladder-emptying problems. </p>
<p>The review didn’t look at the use of cranberry for the treatment of UTI – and cranberry juice <a href="https://kidney.org.au/uploads/resources/KHA-Factsheet-urinary-tract-infections-2018.pdf">cannot cure a UTI on its own</a>. So, if you do get a UTI make sure you seek medical care from your GP or other health provider.</p>
<h2>Remind me, what is a UTI?</h2>
<p>UTIs are unpleasant and very common. About <a href="https://kidney.org.au/your-kidneys/what-is-kidney-disease/types-of-kidney-disease/utis">one-third of women</a> will have one at some point in their life. They’re also common among elderly people and those with bladder issues caused by spinal cord injury or other conditions. </p>
<p>Typically, a UTI feels like peeing razor blades and the urine can be smelly, cloudy, and sometimes has blood in it. Other symptoms include the frequent urge to pass urine, a stinging or burning sensation when passing urine, and pain in the lower abdomen or pelvis. </p>
<p>UTIs are caused by bacteria. Normally bacteria do not live in the urinary tract, but when they do, they stick to the bladder wall, multiply and can cause a UTI. </p>
<p>When a UTI persists untreated, the infection can move to the kidneys and cause complications, such as severe pain, or sepsis (a blood infection) in the worst cases. </p>
<p>Most UTIs are effectively and easily treated with antibiotics. Sometimes just one dose of antibiotics can resolve the infection. Unfortunately, for some people, UTIs keep coming back. </p>
<h2>What medicinal properties do cranberries have?</h2>
<p>The <a href="https://www.nationalgeographic.com/science/article/131127-cranberries-thanksgiving-native-americans-indians-food-history">First Peoples of North America</a> have long known the benefits of eating cranberries, including their benefits for bladder problems. </p>
<figure class="align-center ">
<img alt="Cranberries on a bush" src="https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521738/original/file-20230418-24-v1evw9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cranberries are a native fruit of North America.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cranberry-wild-bunch-red-berries-cranberries-2079933316">Shutterstock</a></span>
</figcaption>
</figure>
<p>More recently, in the <a href="https://www.auajournals.org/doi/10.1016/S0022-5347%2817%2950751-X">1980s</a> and <a href="https://jamanetwork.com/journals/jama/fullarticle/366888">1990s</a>, laboratory scientists started to explore several plausible explanations for these benefits. </p>
<p>The most widely accepted explanation is their high concentration of the antioxidant <a href="https://www.sciencedirect.com/science/article/pii/S0753332219305359">proanthocyanidin</a>. Cranberries (<em>Vaccinium macrocarpon</em>) – a native fruit of North America – have a high concentration of proanthocyanidin, which protects the cranberry plant against microbes. </p>
<p>Researchers think the compound also prevents the most common UTI-causing bacteria – <em>Escherichia coli</em> (<em>E.coli</em>) – from sticking to the bladder wall. </p>
<p>It was this apparent ability that researchers concluded was responsible for the cranberry’s medicinal properties. </p>
<p>However, without strong evidence of how or if cranberry worked, health-care providers were left without clear guidance on who might benefit from cranberry. As a result, the ongoing debate in the academic literature has persisted for more than 30 years.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">Phytonutrients can boost your health. Here are 4 and where to find them (including in your next cup of coffee)</a>
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<h2>The evolution of the evidence</h2>
<p>Researchers periodically review the evidence to support tests, treatments and interventions for all sorts of health conditions.</p>
<p>Proving efficacy became a focus with randomised trials starting to be published from 1994. The first Cochrane compilation of four clinical trials on this topic – <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322/full">published in 1998</a> – concluded the evidence was too poor to determine efficacy. </p>
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<img alt="Woman holds per pelvis, in pain" src="https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521743/original/file-20230419-22-eipspl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Researhers have long been investigating the role of cranberries in preventing UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abdominal-pain-woman-stomachache-illness-menstruation-1840882021">Shutterstock</a></span>
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</figure>
<p>A Cochrane Review involves identifying of all the available peer-reviewed academic evidence on a health care or health policy topic. The evidence is reviewed independently and in an unbiased way by members of the <a href="https://www.cochrane.org/">Cochrane Network</a>, a network of independent researchers, professionals, patients and carers interested in answering health questions.</p>
<p>Updates in 2004 and 2008 suggested cranberry products reduced the risk of repeat UTI in women, but most of the studies were not considered high quality evidence and so the findings were not conclusive. </p>
<p>By 2012, <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001321.pub5/full">the volume of evidence had increased</a> to 24 clinical trials, but the data was imprecise and the conclusions were that cranberry juice was of no benefit. </p>
<p>As one of Cochrane’s most popular reviews, and the ever increasing volume of evidence, updating the review was important. </p>
<p>Over time, research has improved in the consistency of how cranberry is consumed – as juice or tablets – as well as improved in the measurement of the effective dosage and estimates of how much active ingredient (proanthocyanidin) in the different products. </p>
<h2>What’s new?</h2>
<p>Our <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001321.pub6/full">Cochrane Review</a> update, published this week, now includes 50 clinical trials of cranberry products. </p>
<p>More than 8,800 people have participated in the clinical trials which randomly assigned people to take either cranberry products or a dummy treatment – either a placebo (a substance that has no therapeutic effect) or “usual care” (where people might receive another preventive product, such as probiotics).</p>
<p>The recent increased volume of high-quality evidence has shown cranberry products work for people who experience recurrent UTI or are susceptible to UTI. Recurrent UTIs are defined as <a href="https://www1.racgp.org.au/ajgp/2021/april/recurrent-utis-and-cystitis-symptoms-in-women">two or more UTIs within six months</a>, or three or more UTIs within a year. </p>
<p>Cranberry products reduce the risk of repeat symptomatic, culture-verified (tested in a laboratory ) UTIs in women (by about 26%), children (by about 54%), and people susceptible to UTI following medical interventions (by about 53%).</p>
<p>The findings don’t relate to people who don’t get UTIs very often but want to avoid them. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">Should pharmacists be able to prescribe common medicines like antibiotics for UTIs? We asked 5 experts</a>
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</em>
</p>
<hr>
<p>What is still unclear is the formulation and dosage of cranberry products. The evidence was not able to clarify whether cranberry tablets or liquids are more effective, what dosage of cranberry works best, or how long people need to take cranberry products to get the full benefits. The clinical trials varied in the duration of cranberry consumption, from four weeks to 12 months. </p>
<p>Among the many complicating issues addressed in this update was who funded each trial. Each clinical trial was classified as either being supported by funds from commercial organisations (such as juice manufacturer) or conducted by not-for-profit organisations (such as universities or hospitals) who paid for their own cranberry product. </p>
<p>However, we found no difference in the results for clinical trials supported by juice companies compared to those conducted by academic institutions.</p><img src="https://counter.theconversation.com/content/203926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Stephens receives funding from NHMRC, Channel 7 Children's Research Foundation, Ferring Pharmaceuticals, and Flinders Foundation.</span></em></p><p class="fine-print"><em><span>Gabrielle Williams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new review shows consuming cranberry products reduces the chance of repeat UTIs for women, children, and those who are more susceptible to them due to medical procedures.Jacqueline Stephens, Epidemiologist & Senior Lecturer in Public Health, Flinders UniversityGabrielle Williams, Epidemiologist, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1889552022-09-02T16:32:46Z2022-09-02T16:32:46ZUTIs are still diagnosed using a 140-year-old method – here’s why<figure><img src="https://images.theconversation.com/files/482058/original/file-20220831-4904-izsau9.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3994%2C1790&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This common testing technique was first invented in 1887.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/e-coli-colonies-gnr-gram-negative-2066799596">Babul Hosen/ Shutterstock</a></span></figcaption></figure><p>If you’ve ever had a urinary tract infection (UTI) before, you know what a pain it can be. Not just because of the physical pains it causes, but because it can also be such a pain to go to the doctor, provide a urine sample, and wait for your results.</p>
<p>UTIs are extremely common, with nearly <a href="https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/background-information/prevalence/">half of women</a> getting one at some point in their lifetime. In order to test for a UTI, a urine sample needs to be sent to a hospital microbiology lab. </p>
<p>There, they will look for bacteria that cause infections and check if these bacteria are resistant to antibiotics. This is typically done by using a technique called agar plating. A small amount of urine is put on to a small round dish filled with a nutrient jelly called agar, which is kept warm overnight to allow any bacteria to grow.</p>
<p>This common technique has been around for <a href="https://www.immunology.org/culture-plate-1887">nearly 140 years</a> and remains the clinical standard in many hospitals. But in an age when we can instantly test for a COVID-19 infection, measure blood glucose with an electronic reader, and wear wrist watches that track our heart rates, why do we still use this old method that takes days to accurately diagnose a UTI?</p>
<h2>It’s actually pretty clever</h2>
<p>If an infection is suspected, it’s important to know what type of bacteria (if any) are present, how many are in your urine, and which antibiotic those bacteria can be treated with.</p>
<p>But urine samples can also contain a lot of other stuff – such as urea and salts, and different levels of acidity – that might affect the detection of bacteria. Spreading the urine on agar removes anything that might interfere with bacterial growth. </p>
<p>This technique also allows single cells in the sample to form blobs (called colonies) which are easy to count. The shape, colour, size and even smell of colonies can be used to indicate which types of bacteria are present. Some samples contain several different types of bacteria, and these must be isolated and tested separately. </p>
<p>It’s surprisingly hard to find alternative methods that can do all of these essential things without being affected by other urine components. </p>
<h2>The best-known method</h2>
<p>We have a lot of experience using the agar plating technique because we’ve used it for years. This means we have a pretty good understanding of how to make use of the results – not only in diagnosing a person’s infection but (where necessary) to adjust the treatment they are given.</p>
<p>But that doesn’t mean the system is perfect. The current method of agar plating takes several days to identify what antibiotics would treat the infection best – which is too long for a patient to wait. This means we have to start treating patients before the test results are known.</p>
<figure class="align-center ">
<img alt="A lab technician swabs a sample onto a petri dish. There are a stack of other petri dishes waiting for samples in the background." src="https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482059/original/file-20220831-18-3h2hxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">One of the main disadvantages is that it’s slow.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-media-plate-on-hand-medical-584421841">AnaLysiSStudiO/ Shutterstock</a></span>
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<p>Sometimes this means patients have to switch drugs after a few days, which is inconvenient and expensive. Using more antibiotics <a href="https://microbiologysociety.org/publication/briefing/antimicrobial-resistance-explainer.html">fuels antibiotic resistance</a>, making the problem worse in future. These problems are helping to <a href="https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2019-to-2024">drive innovation</a> in <a href="https://www.who.int/publications/i/item/9789241509763">microbiology testing</a>.</p>
<h2>New technologies still need improvement</h2>
<p>Although current tests can measure bacteria and antibiotic resistance in urine, we need tests that can do this more rapidly to allow testing to happen before treatment. These methods ideally need to be portable and inexpensive so we can use them in the community, without sending samples to labs.</p>
<p>Recent progress suggests this may be possible. For example, digital cameras can detect if bacterial cells are growing on a <a href="https://pubs.rsc.org/en/content/articlelanding/2013/LC/C2LC41055A">microscopic scale</a> or in <a href="https://onlinelibrary.wiley.com/doi/10.1002/smll.202004148">diluted urine</a>. While these methods take a few hours to check if an antibiotic will work, it’s still far quicker than agar plating.</p>
<p>Some hospital laboratories also now routinely use a technique called <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2015.00791/full">mass spectrometry</a>, which measures fragments of a bacterial sample and compares them with a database to identify the bacteria. This speeds up the testing of colonies found on agar plates, replacing days of work previously needed to accurately identify bacterial species. </p>
<p>But while these new methods show promise, many are only at the research stage. And in the case of mass spectrometry, agar plating is still required for antibiotic susceptibility testing. Many of these technologies are also too big and expensive for a GP or pharmacy – so urine samples still need to be transported to hospital labs for analysis.</p>
<p>In the future, such technologies need to reduce the time it takes for a person to receive their diagnosis while remaining as affordable and accessible as agar plating. This is something our lab is <a href="https://pubs.rsc.org/en/content/articlelanding/2022/AN/D2AN00305H">working towards</a>.</p>
<p>We’ve already found that we can manufacture smaller, more portable tests that are <a href="https://pubs.rsc.org/en/content/articlepdf/2021/ra/d1ra06867a">just as accurate</a> as agar plating – and the results can be recorded with a cheap digital camera such as a smartphone. Our <a href="https://fundingawards.nihr.ac.uk/award/NIHR203362">next stage</a> of research is to check these “tiny tests” work with real patient samples.</p>
<p>It’s vital that some of the new, rapid UTI tests make their way into common practice, to ensure every case is treated quickly and effectively with the correct antibiotic. However, it will be some time before these and other new technologies are routinely used for diagnosis. For now, people who suspect they have a UTI still need to go to their GP in order to be diagnosed and given the proper medication.</p><img src="https://counter.theconversation.com/content/188955/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Edwards is a director of and owns shares in Capillary Film Technology Ltd a UK company founded to develop diagnostic applications of microcapillary film technology. He receives funding from the National Institutes of Health and Care Research (NIHR) with grant number NIHR203362. </span></em></p><p class="fine-print"><em><span>Sarah Needs receives funding from the National Institute of Health and Care Research (NIHR) with grant number NIHR203362</span></em></p>While newer, faster technologies are in development, it will still be some time before they’re in regular use.Alexander Edwards, Associate Professor in Biomedical Technology, University of ReadingSarah Needs, Postdoctoral Research Associate, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1756502022-06-10T12:29:55Z2022-06-10T12:29:55ZSepsis still kills 1 in 5 people worldwide – two ICU physicians offer a new approach to stopping it<figure><img src="https://images.theconversation.com/files/467853/original/file-20220608-22-nfife2.jpg?ixlib=rb-1.1.0&rect=59%2C0%2C6540%2C2642&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sepsis begins with infection by bacteria or a virus. This panoramic ilustration inside a blood vessel shows rod-shaped bacteria, red blood cells and immune cells called leukocytes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/bacteria-in-blood-illustration-royalty-free-illustration/685024929?adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p>Can an otherwise healthy young woman die from what starts out as something akin to a common cold? The answer is, <a href="https://www.bbc.com/news/uk-wales-45498914">shockingly, yes</a>, when certain telltale signs of a more serious problem go undetected. </p>
<p>Though many people haven’t even heard of it, sepsis – the body’s extreme response to infection – is <a href="https://www.natlawreview.com/article/sepsis-accounts-1-5-deaths-leading-cause-death-hospitals#">the leading killer of hospitalized patients</a> in the United States. Worldwide, sepsis is responsible <a href="https://doi.org/10.1016/S0140-6736(19)32989-7">for 1 in 5 deaths every year</a>. <a href="https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome">Even among those who survive</a>, many will never be able to return to work, and some won’t be able to return home from the hospital, requiring life support or ongoing critical care.</p>
<p>We <a href="https://pre.ccm.pitt.edu/?q=content/rudd-kristina">are two researchers</a> and <a href="https://www.ccm.pitt.edu/node/1211">critical care doctors</a> at the University of Pittsburgh School of Medicine who are working to change the way scientists and doctors think about sepsis. We are interested in understanding and spreading awareness about how sepsis starts and how it can elude even the most astute physicians. </p>
<p>We are also learning more about how community factors are at play and how a better understanding of the communities we all live in could help everyday people and health care workers alike recognize and stop this deadly disease.</p>
<h2>What is sepsis?</h2>
<p>Sepsis is a medical emergency that begins with an infection – perhaps even a mild infection. Upon detecting bacteria or a virus, your body releases a choreographed cascade of chemicals into the bloodstream. This chemical alert beckons <a href="https://theconversation.com/how-long-does-protective-immunity-against-covid-19-last-after-infection-or-vaccination-two-immunologists-explain-177309">an artillery of immune cells</a> that work in concert to fight the bug. </p>
<p>When this system works well, your body clears the infection and you get better. But when the system doesn’t work well, sepsis can ensue.</p>
<p>The onset of sepsis occurs when your immune cells pivot from fighting the infection to fighting your own tissues and organs. This reaction can be similar to an autoimmune response, a condition in which <a href="https://medlineplus.gov/autoimmunediseases.html">the body’s immune system turns on itself</a>. Many people are familiar with chronic autoimmune diseases such as <a href="https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html#">rheumatoid arthritis</a> or <a href="https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304#">Crohn’s disease</a>, but sometimes this type of autoimmune response can occur even in healthy people. </p>
<p>When sepsis occurs, the immune system can commonly injure the heart, lungs, kidneys or blood cells, among other important body systems. Inflammation in the blood vessels can make them leaky, causing blood flow to the brain and other organs to become severely diminished. When this occurs, a person’s blood pressure may become dangerously low, which is a severe form of sepsis known as septic shock. </p>
<p>Without prompt and proper treatment – and sometimes even despite treatment – sepsis can cause organ damage and even death. Once shock develops, mortality from sepsis is estimated <a href="https://doi.org/10.1001/jama.2016.0287">to jump from 10% to as high as 40%</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/6NdLnHbLZMU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An illustrated explanation of how sepsis attacks the body.</span></figcaption>
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<p>Sepsis can result from nearly any infection. Most commonly it develops from pneumonia or a urinary tract infection. Severe <a href="https://www.ama-assn.org/delivering-care/public-health/sepsis-survival-has-lessons-severe-covid-19-care-recovery">COVID-19 can also cause sepsis</a>. Often, sepsis patients are seen by a medical professional for infection symptoms <a href="https://doi.org/10.4037/ajcc2021456">in the week preceding sepsis hospitalization</a>. However, predicting which infected patients will go on to develop sepsis is very difficult.</p>
<h2>Treatment options</h2>
<p>The cornerstones of sepsis treatment are prompt recognition of sepsis symptoms, followed by antibiotics and fluids. But even the most careful and attentive physicians can miss the early signs of sepsis. </p>
<p>This is largely because there is no single test to positively diagnose sepsis. Sepsis symptoms may mimic other life-threatening conditions such as heart attacks, blood clots, bleeding or even an allergic reaction. Patients often display vague and variable symptoms such as weakness, lightheadedness and rapid breathing, making the diagnosis even more challenging. </p>
<p>For example, a young, otherwise healthy person with sepsis due to pneumonia may look much different from an older diabetic who develops sepsis from a smoldering skin infection.</p>
<p>Sepsis patients nearly always require admission to the hospital or even the ICU, and those with severe forms of sepsis often require life support. This may include dialysis or mechanical ventilation to support failing organs. The source of infection needs to be identified and, in some cases, surgically removed. Delaying sepsis treatment by even a few hours <a href="https://doi.org/10.1007/s00134-021-06506-y">can have deadly consequences</a>. </p>
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<figcaption><span class="caption">Sepsis can affect those of any age, not just the elderly.</span></figcaption>
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<h2>Recognizing sepsis before it’s too late</h2>
<p>Differences in sepsis go beyond symptoms. COVID-19 has laid bare that severe illness isn’t a game of chance. Like COVID-19 infection, sepsis susceptibility – and who is most likely to get sick and die – is part of a complex interplay of social influences that <a href="https://doi.org/10.1001/jama.2021.22583">include racism, poverty, geography and community dynamics</a>.</p>
<p>Research strongly suggests that certain people are at <a href="https://doi.org/10.1093/ofid/ofy305">far higher risk of developing sepsis</a> than others. Much like COVID-19, older people with underlying chronic diseases like obesity and diabetes face a heightened risk for sepsis. Such factors as race, poverty and even driving distance to the hospital <a href="https://doi.org/10.1016/j.chest.2016.07.004">may have a significant impact</a> on who survives sepsis. </p>
<p>Most of the work done to improve sepsis detection and treatment has focused on the hospital setting. Doctors, researchers and even government agencies have concentrated their efforts on improving sepsis recognition and treatment once a patient reaches the hospital. Research aimed at understanding an individual’s sepsis risk has focused on personal health history and social and economic factors such as income and race, or community features such as primary care access. </p>
<p>While these approaches have advanced the field’s understanding of sepsis, they have led to little progress in reducing the incidence of sepsis in the U.S.</p>
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<figcaption><span class="caption">Sepsis is sometimes mistaken for the flu.</span></figcaption>
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<h2>New approaches to catching a killer</h2>
<p>Given what is known about the importance of early sepsis treatment, researchers like us are taking a closer look at the role of communities in improving sepsis detection and understanding sepsis risk.</p>
<p>The early stages of sepsis can evolve rapidly when a patient is at home. Scientists estimate that <a href="https://www.cdc.gov/sepsis/what-is-sepsis.html">87% of sepsis cases start outside the hospital</a>. When a patient does present for care, it’s often in a clinic or emergency medical services setting in the days and even hours <a href="https://doi.org/10.1164/rccm.201204-0713OC">preceding sepsis hospitalization</a>. These critical treatment windows may mean the difference between life and death for a sepsis patient. </p>
<p>Alongside researchers based at Kaiser Permanente Northern California, we are now working to advance sepsis care by studying sepsis patient symptoms, community factors, diagnosis and treatment patterns outside the hospital. We are also expanding work to <a href="https://doi.org/10.1038/s41746-022-00580-2">improve sepsis diagnosis among hospitalized patients</a>. This coast-to-coast collaboration will study patients cared for at over 40 hospitals, 30 EMS agencies and a critical mass of ambulatory clinics. We hope that our work will shed light on the early stages of sepsis, including signs that may signal that an infected patient is progressing to sepsis, and explore diagnostic and treatment approaches that could help stop sepsis before it advances too far. </p>
<p>We are also learning a great deal more about the complicated role of community factors like poverty on health outcomes, including sepsis. Using “syndemic theory” – a framework to describe synergistic epidemics that <a href="https://doi.org/10.1016/S0140-6736(17)30003-X">arise from harmful social conditions</a> – we are studying how two co-occurring epidemics, like poverty and asthma, can work together to increase negative health outcomes. Though this framework is only beginning to be used to study acute illness, it has the potential to transform the way we think about sepsis.</p><img src="https://counter.theconversation.com/content/175650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Brant works for the University of Pittsburgh School of Medicine and UPMC Health System. She has received grant funding from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) and the Gordon and Betty Moore Foundation. She has no relevant conflicts of interest to report. </span></em></p><p class="fine-print"><em><span>Kristina E. Rudd works for the University of Pittsburgh and UPMC Health System. She consults for Janssen Pharmaceuticals. She receives grant funding from the National Institute of General Medical Sciences and the National Heart, Lung, and Blood Institute (National Institutes of Health).</span></em></p>Sepsis onset can be difficult to recognize, in part because its symptoms can mimic those of many other conditions. A treatment delay of even a few hours can make the difference between life and death.Emily Brant, Assistant Professor of Critical Care and Emergency Medicine, University of PittsburghKristina E. Rudd, Assistant Professor of Critical Care Medicine, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200952019-07-15T00:12:23Z2019-07-15T00:12:23Z1 in 10 patients are infected in hospital, and it’s not always with what you think<figure><img src="https://images.theconversation.com/files/283457/original/file-20190710-44472-1mqt2eb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drips and other medical devices were potential sources of infection. But no-one expected to find hospital-acquired pneumonia and urinary tract infections.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/anesthesiologist-nurse-open-intravenous-fluid-225255157?src=oS27Q0yT7trUvePFlYlWwg-1-43&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Most people expect hospital treatment to make them better. But for some, a stay in hospital can actually make them sicker. Their wound might get infected after an operation or they might get a blood infection as a result of a medical procedure.</p>
<p>Our study, published today in the international journal <a href="https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0570-y">Antimicrobial Resistance and Infection Control</a>, found one in ten adult patients in hospital with an acute (short-term) condition had a health care associated infection.</p>
<p>In the first study of its kind in Australia for over 30 years, we also uncovered unexpected infections, like pneumonia and urinary tract infections, as well as high numbers of patients with multi-drug resistant organisms (superbugs).</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/infections-complications-and-safety-breaches-why-patients-need-better-data-on-how-hospitals-compare-86748">Infections, complications and safety breaches: why patients need better data on how hospitals compare</a>
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<h2>Why do we need to keep track of infections?</h2>
<p>Most of these infections can be prevented. So it is important to know what type of infections they are, how common they are and which patients get them. Once we have this information, we can work out a way to prevent them. </p>
<p>Left unchecked, these infections can make already sick patients sicker, can divert hospital resources unnecessarily, and can kill.</p>
<p>Most hospitals in Australia have ongoing surveillance for specific infections, such as wound and bloodstream infections. </p>
<p>Some states have well coordinated programs like the Victorian program <a href="https://www.vicniss.org.au">VICNISS</a>, leading to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25782895">detailed data</a> on health care associated infections. This data is then used to inform hospital strategies on how to prevent infections. However, this type of surveillance method requires extensive resources and does not capture all infections that occur in a hospital.</p>
<p>Instead, we conducted a “point prevalence” survey, which takes a snapshot of the current situation on any given day. This is less resource intensive than ongoing surveillance and it provides valuable information on the distribution and occurrence of <em>all</em> infections in a hospital.</p>
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<strong>
Read more:
<a href="https://theconversation.com/some-private-hospitals-are-safer-than-others-but-we-dont-know-which-77096">Some private hospitals are safer than others, but we don't know which</a>
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<p>In Europe, the <a href="https://ecdc.europa.eu/en/healthcare-associated-infections-acute-care-hospitals/facts/about">European Centre for Disease Prevention and Control</a> co-ordinates national point prevalence studies every four years. These have provided valuable insight into the burden of health care associated infections. They have also been used to track the emergence of multi-drug resistant organisms in Europe. The US, Singapore and many other countries also run them. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Most hospital infections can be prevented.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/633363035?src=jhlWisgjKa449M1gf5-h5A-1-101&studio=1&size=huge_jpg">Santypan/Shutterstock</a></span>
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<p>Unlike <a href="https://www.cdc.gov/nhsn/index.html">most OECD countries</a>, Australia does not have a national health care associated infection surveillance program and does not undertake national point prevalence studies. </p>
<p>The only national data routinely collected relates to <a href="https://www.myhospitals.gov.au/our-reports/healthcare-staphylococcus-aureus-bloodstream/february-2019/overview">bloodstream infections</a> caused by the microorganism <em>Staphylococcus aureus</em>. These infections are serious but rare and only represent a tiny fraction of all infections in hospitals.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/golden-staph-the-deadly-bug-that-wreaks-havoc-in-hospitals-39790">Golden staph: the deadly bug that wreaks havoc in hospitals</a>
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</em>
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<p>To improve our understanding of health care associated infections across Australia, we used the same study method as the Europeans. Over a four month period in 2018, we visited 19 large hospitals across Australia and collected information on all infections in adult acute inpatients. Four of the hospitals were regional, the others major city hospitals.</p>
<h2>What infections did we find?</h2>
<p>Of the 2,767 patients we surveyed, we found 363 infections in 273 patients, meaning some patients had more than one infection. The most common infections were wound infections after surgery (surgical site infections), pneumonia and urinary tract infections. These accounted for 64% of all the infections we found. </p>
<p>This is important as most hospitals do not normally look for pneumonia or urinary tract infections and there is no routine statewide or national surveillance for these. </p>
<p>Our findings mean these infections are commonly occurring but undetected. A potential source of information on these types of infections is hospital <a href="https://www.ihpa.gov.au/what-we-do/ar-drg-classification-system">administrative coding data</a>. However, these codes were mainly designed for billing purposes and have been shown to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/24218103">unreliable</a> when it comes to identifying <a href="https://www.ncbi.nlm.nih.gov/pubmed/26316651">infections</a>.</p>
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<em>
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Read more:
<a href="https://theconversation.com/we-know-why-bacteria-become-resistant-to-antibiotics-but-how-does-this-actually-happen-59891">We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?</a>
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<p>We also found patients with a medical device, such as a <a href="https://www.cdc.gov/hai/bsi/catheter_faqs.html">large intravenous drip</a>, or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-catheterisation">urinary catheter</a> (a flexible tube inserted into the bladder to empty it of urine), were more likely to have an infection than those who did not. </p>
<p>Intensive care units treat patients who are gravely unwell and at greater risk of infection. So it was unsurprising to find that 25% of patients in intensive care units had a health care associated infection.</p>
<p>The emergence of multi-drug resistant organisms (<a href="https://theconversation.com/explainer-what-are-superbugs-and-how-can-we-control-them-44364">superbugs</a>) is a concern worldwide. Previously unknown, our study revealed that 10% of the adult acute inpatients in our study had a multi-drug resistant organism.</p>
<h2>What have other studies found?</h2>
<p>For the first time in 34 years we have a glimpse of how common health care associated infections are in Australian hospitals. Although the only other <a href="https://www.ncbi.nlm.nih.gov/pubmed/3143900">previous study</a> was larger, a major strength of our study is that we used the same two trained data collectors to collect the data from all hospitals. </p>
<p>This reduced the potential inconsistency in finding infections that might occur if hospital staff collected their own data. It also minimised the use of hospital resources to undertake the survey.</p>
<p>Importantly though, we did not survey all types of hospitals. It is possible that if the same survey was extended to include children, babies and cancer hospitals, higher rates of infection may be found given the vulnerability of these patients.</p>
<h2>What can we do better?</h2>
<p>As one of the authors has <a href="https://theconversation.com/heres-how-many-people-get-infections-in-australian-hospitals-every-year-82309">previously noted</a>, a major gap in Australia’s effort to combat health care associated infections, and the emergence of multi-drug resistance organisms, is the lack of robust national data.</p>
<p>This means we cannot measure the effect of national policy or <a href="https://www.nhmrc.gov.au/health-advice/public-health/preventing-infection">guidelines</a> despite significant investment.</p>
<p>In the absence of a national surveillance program, we recommend that large-scale point prevalence surveys, including smaller hospitals, specialist hospitals and the private sector be undertaken regularly. Data generated from these studies could then be used to inform and drive national infection prevention initiatives.</p><img src="https://counter.theconversation.com/content/120095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Russo receives funding from a National Health and Medical Research Council Early Career Fellowship, and is also President Elect of the Australasian College for Infection Prevention and Control. He was a member of the NHMRC Infection Control Guideline Advisory Committee, and a former member of the Healthcare Infection Advisory Committee of the Australian Commission for Safety and Quality in Health Care.
This project was wholly funded by a grant from the Rosemary Norman Foundation, a philanthropic nursing charity. None of the researchers receive any income from the funding or have any role with the charity. The Foundation was not involved in the design nor the conduct of the study, and will not benefit in any form from the results of the study. In-kind support was provided by the Centre for Quality and Patient Safety Research, Deakin University, Monash University and Avondale College of Higher Education.</span></em></p><p class="fine-print"><em><span>Brett Mitchell has received funding from the HCF Foundation and the NHMRC. Brett is the Editor-in-Chief of Infection, Disease and Health. This project was wholly funded by a grant from the Rosemary Norman Foundation, a philanthropic nursing charity. None of the researchers receive any income from the funding or have any role with the charity. The Foundation was not involved in the design nor the conduct of the study, and will not benefit in any form from the results of the study. In-kind support was provided by the Centre for Quality and Patient Safety Research, Deakin University, Monash University and Avondale College of Higher Education.</span></em></p>A surprising number of people are catching pneumonia or urinary tract infections in hospital, a new Australian study shows for the first time.Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash UniversityBrett Mitchell, Professor of Nursing, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/823092017-08-15T20:17:54Z2017-08-15T20:17:54ZHere’s how many people get infections in Australian hospitals every year<figure><img src="https://images.theconversation.com/files/182036/original/file-20170815-18355-1pfyowb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Initiatives in infection prevention and control remain critical at all levels of government and in hospitals.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Around 165,000 Australians contract infections in hospitals around the country every year, a study has found. The infections, which include urinary tract, staph, surgical site and respiratory infections in stroke patients, can lead to death in patients who are already sick and have weakened immune systems.</p>
<p>Our research, published today in the Australian peer-reviewed journal <a href="https://doi.org/10.1016/j.idh.2017.07.001">Infection, Disease and Health</a>, analysed studies on hospital-acquired infections in Australia from 2010 to 2016. </p>
<p>Australia does not undertake surveys of the prevalence of infections in hospital, nor does it have a national surveillance system that collects and reports data on hospital-acquired infections. We are one of the only countries in the OECD that lacks such basic information.</p>
<p>It is well recognised that surveillance of infection is the cornerstone of infection prevention. Yet this is essentially absent at a national level. Given the number of hospital-acquired infections each year, and increasing resistance to antibiotics, investment and initiatives in infection prevention and control remain critical at all levels of government and in hospitals.</p>
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Read more:
<a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">Washing our hands of responsibility for hospital infections</a>
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<h2>The risk of going to hospital</h2>
<p>Imagine you were heading out tonight. On the way home, you decide to catch public transport. You are about to hop onto a bus when the driver stops you and says:</p>
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<p>I better tell you, there is a 6% chance we will have an accident on the way home. It could be minor, or you could die. </p>
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<p>What would you do? Many people would likely thank the bus driver, not catch the bus and look for an alternative. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182038/original/file-20170815-5720-cuzbpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Imagine if you knew the exact risk of having an accident each time you got on a bus.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>But now imagine you want to know what the risk of infection in a particular hospital is. This is a pretty basic question, but unfortunately, while many countries can answer it, we can’t. In Europe for instance, <a href="https://ecdc.europa.eu/en/healthcare-associated-infections-acute-care-hospitals/surveillance-disease-data/report">6% of patients</a> have an infection acquired in hospital. </p>
<p>Many of these hospital-acquired infections that occur as a result of a health-care intervention make patients sicker and require ongoing treatment, while others may be life-threatening. </p>
<p>Everyone is of course susceptible to infection, but patients receiving health care are often more at risk. This is because patients may be having procedures such as surgery, receiving treatment that suppresses the immune system or have other existing medical conditions. </p>
<p>Patients often don’t have a choice about going to hospital, unlike choosing not to catch a bus. This places even more onus on hospitals and health-care facilities to reduce the risk of infection. </p>
<h2>What infections could you get?</h2>
<p>Our review of the literature found between 2010 and 2016, there were 83,096 hospital-acquired infections in Australia every year. But given the lack of or incomplete data on common infections such as pneumonia, which altogether missed up to 50-60% of infections, we calculated the incidence of hospital-acquired infections in Australia may be closer to 165,000 per year.</p>
<p>Of these, there are an estimated 71,000 urinary tract infections and 4,900 cases of infection with the bacteria <em>Clostridium difficile</em>, which causes symptoms such as diarrhoea, fever, nausea, and abdominal pain. More than 1,100 cases of <em>Staphylococcus aureus</em> (golden staph) infections were also estimated to occur. </p>
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<p>The latter is the only infection for which data is collected and <a href="http://www.myhospitals.gov.au/compare-hospitals/healthcare-staphylococcus-aureus-bloodstream/interactive-table">reported on nationally</a>. Despite being less common, blood stream infections are associated with a <a href="http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12195/full">death rate of 20%</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/golden-staph-the-deadly-bug-that-wreaks-havoc-in-hospitals-39790">Golden staph: the deadly bug that wreaks havoc in hospitals</a>
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<p>Other infections not only contribute to sickness and death, but place pressure on the health-care system by patients staying longer in hospital and consuming resources. Health-care associated urinary tract infections have been estimated to use approximately <a href="http://www.sciencedirect.com/science/article/pii/S0195670116000682">380,600 extra public hospital bed days</a> each year in Australia. </p>
<p>While not all hospital-acquired infections are preventable, <a href="https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/estimating-the-proportion-of-healthcare-associated-infections-that-are-reasonably-preventable-and-the-related-mortality-and-costs/85B4290844BF00DF4530EBB2E5BEDC2D">many are</a>. This study suggests 65-70% of catheter-associated bloodstream infections and catheter-associated urinary tract infections can be prevented. </p>
<p>Infections occur when microorganisms are introduced into a part of the body that would not normally have them. For example, bacteria in a wound, in the blood stream or in the bladder, might cause an infection. </p>
<p>In health-care settings, microorganisms - that are a normal part of the human body - are often transferred on the hands of health-care workers and can be found in the patient environment. <a href="http://www.sciencedirect.com/science/article/pii/S0195670115003126">Evidence suggests</a> patients admitted to a room previously occupied by a carrier of bacteria that has become resistant to drugs have a significantly higher risk of acquiring that bacteria. </p>
<p>This demonstrates the role of the hospital environment in infection transmission and infers that current cleaning practices in hospital fail to reduce the risk of infections. <a href="http://www.idhjournal.com.au/article/S2468-0451(16)30077-3/pdf">Cleaning is as fundamental as hand hygiene</a> in the prevention of disease causing organisms, especially in light of growing resistance to antibiotics and difficult-to-treat superbugs. Surveillance of infection is one way we can continue to observe the effectiveness of cleaning in conjunction with other prevention initiatives. </p>
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<p>
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Read more:
<a href="https://theconversation.com/recent-death-from-resistant-bug-wont-be-the-last-71340">Recent death from resistant bug won't be the last</a>
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<h2>We need a national strategy</h2>
<p>Recently, <a href="http://www.deakin.edu.au/about-deakin/media-releases/articles/deakin-to-undertake-national-hospital-infection-audit">Deakin University announced</a> their researchers would conduct the first infection survey of Australian hospitals in 30 years. This is not funded or organised by government, but rather a philanthropic grant. </p>
<p>Understanding the number and type of infections is critical to decision making, setting policy direction and evaluating the effect of interventions. It’s quite remarkable a major patient safety issue in hospitals lacks such basic transparent data.</p>
<p>The burden and impact of hospital-acquired infections is set to increase with the rise of resistance to antibiotics. Treatment of infection is getting more difficult and this is set to continue. Studies from Europe and <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1306801#t=article">the US</a> suggest the most common hospital infections are pneumonia, urinary tract infections and those at the surgical site. In Australia there is <a href="https://ipcca.com.au/infectiondigest-blog/">no data on the incidence</a> or prevalence of health-care associated pneumonia.</p>
<p>There has been considerable work done in infection prevention in Australia, including a <a href="https://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/hand-hygiene/">national hand hygiene initiative</a> and a <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-amr.htm">national strategy</a> to address resistance to antibiotics. The latter is supported by millions of dollars in government grants to establish centres of research excellence focusing on resistance. </p>
<p>However, a major gap still remains - a coordinated national hospital-acquired infections surveillance program. Such a program is needed so interventions can be appropriately planned and evaluated.</p><img src="https://counter.theconversation.com/content/82309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brett Mitchell receives funding from industry grants and is a Chief Invesitgator on NHMRC grants, both of which fund research projects. Brett Mitchell is Editor-in-Chief of Infection, Disease and Health (Australian based peer reviewed journal) and is the Chair of a NHMRC committee revising national infection control guidelines. He has undertaken consultancy work for the Australian Commission on Safety and Quality in Health Care and Department of Foreign Affairs and Trade.</span></em></p>Australia does not have a national system that collects data on hospital acquired infections. But new research has shed light on how many do occur each year across the country.Brett Mitchell, Professor of Nursing, Avondale College of Higher EducationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/689762016-11-17T07:53:05Z2016-11-17T07:53:05ZCranberries can’t cure UTIs, and other good reasons to publish negative research results<figure><img src="https://images.theconversation.com/files/146320/original/image-20161117-13340-y1jpgx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/29682030@N00/312237886/in/photolist-tAirQ-48ncaK-3j2eQt-8WDaJV-8P37f3-7uBwM-aMZqqp-pPMfS5-rz3qN9-e7N7hS-96FYBT-iSBSrk-5PwEUe-iFL3iq-48xhJJ-pmFctB-924bM7-7vydSu-7hdJJj-8Jrqvb-e7N1K1-bG7b8x-8Jon6X-t2TAN-67UzLs-aYHrur-7MuAP-4a5R35-aMZqrF-tdp47-9aky1o-5qGqQ-aMZqtD-4cKgft-8XtAox-d8amm5-nuz8x-4a5QRq-4iPjgC-8njGik-7fABWt-4fTd86-8JksYP-7vydSU-8pWzX-gsfLUt-95AXuG-8JojXg-8Jou6L-6SKW5v">Bruce Foster/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Cranberries, the little red berries from North America, are not effective for curing urinary tract infections. This piece of information is bound to disappoint the women who have been swallowing cranberry capsules for years in the hope that it was. But, alas, this is what science shows. </p>
<p>These results <a href="http://jamanetwork.com/journals/jama/fullarticle/2576822">were published</a> on October 27 in the prestigious medical journal JAMA. For the experiment, older women living in nursing homes were administered cranberry capsules for a year, while others were given a placebo pill. The comparison did not reveal any significant difference in the presence of bacteria in their urine. </p>
<p>This work is the latest example of publication of a study yielding results that were <a href="https://theconversation.com/pourquoi-il-faut-faire-plus-attention-aux-resultats-negatifs-des-etudes-cliniques-60964">the opposite</a> of what was expected.</p>
<p>In the editorial that <a href="http://jamanetwork.com/journals/jama/fullarticle/2576821">was published in the same journal</a>, a Canadian researcher acknowledges this disappointment and writes that cranberry <a href="https://www.anses.fr/fr/content/canneberge-et-infections-urinaires">once constituted a nice hope</a> in the fight against urinary tract infections, but that it is now time <a href="http://www.h2mw.eu/redactionmedicale/2016/10/le-jama-et-la-plupart-des-revues-prestigieuses-publient-des-r%C3%A9sultats-n%C3%A9gatifs-mais-il-faut-que-ces-.html">to move on to something else</a>. </p>
<p>This proves that a so-called “negative study” is anything but useless.</p>
<p>Negative studies like this one are scarce in scientific journals today. Indeed, researchers tend to practice self-censorship; they don’t even submit negative studies for publication. So my colleagues and I have created an online journal exclusively dedicated to the subject, called <a href="http://www.negative-results.org">Negative Results</a>. </p>
<p>We <a href="http://www.negative-results.org/index.php/about-our-company/">four founders</a> are all young French researchers in biology: Antoine Muchir, Rémi Thomasson, Yannick Tanguy and Thibaut Marais. We’re motivated by the same purpose, namely that scientific quests resulting in failure should be considered for what they are worth. And their <a href="http://www.la-croix.com/Sciences/Sciences/Que-nous-apprennent-etudes-scientifiques-negatives-2016-10-18-1200797011">results should be accessible to everyone</a>.</p>
<p>Leading international figures have joined our editorial committee and will help us guarantee the quality of the publications that will be put online. The American Alzheimer’s researcher <a href="http://www.utsa.edu/biology/faculty/GeorgePerry.html">George Perry</a>, from the University of Texas in San Antonio, has decided to join our team, as has Columbia University nephrologist Simone Sanna-Cherchi. We aim to publish our first research articles by the end of the year.</p>
<h2>Why publish negative results?</h2>
<p>One year ago, the four of us were sitting in an amphitheatre at Pierre and Marie Curie University, in Paris. A colleague was defending her PhD thesis there. In our field, a thesis represents three years of strenuous work spent between lab benches and computer screens. </p>
<p>The point is to verify an original hypothesis, which quickly leads to a multitude of secondary hypotheses that must also be tested. All these experiments must result in scientific publications if doctoral students want to earn recognition from the scientific community and to make progress. Their future careers largely depends on this.</p>
<p>On that day, the future doctor in biology passed with distinction. But, despite the quality of her research, she had failed to publish a single article in peer-reviewed journals. Why? Because the results she obtained did not confirm her starting hypothesis. She had invalidated her hypothesis, demonstrating that it was false.</p>
<h2>Not duplicating experiments to no avail</h2>
<p>It seemed inconceivable to us that this student’s considerable work and effort should leave no trace in the field of research and that no one beyond us, the audience of that day, should ever know that the lead this researcher had followed led to nowhere. </p>
<p>What if another researcher tried to undertake the same project tomorrow, only to end at the same impasse? In biology, taking into account the equipment and the researcher’s time, one year of research costs an average of €60,000. It is costly to duplicate fruitless experiments.</p>
<p>Negative Results emerged from the shared idea that there must be a way to avoid such waste. Publishers frequently say that “negative” data fails to draw readership and is therefore of little value to the journal because it limits its impact and citations. We are of a different opinion: even invalidated hypotheses must be made available to everyone. </p>
<p>On occasion, negative studies do get published, like JAMA’s debunking of cranberries’ medicinal uses. But it’s just the tip of the iceberg. <a href="http://www.nature.com/news/social-sciences-suffer-from-severe-publication-bias-1.15787">According to a 2014 article in Nature</a>, only 20% of negative studies see the light of day; the other 80% remain in the shadowy depths. </p>
<p>We do not deny the fact that some efforts have been made in recent years to overcome this difficulty. The open-access publication mode has reshaped the landscape of scientific publications. And, here and there, journals do accept negative results. </p>
<h2>Pharmaceutical drugs</h2>
<p>This is particularly true in pharmaceutical drug research. In that field, historically, clinical trials are considered an “advance” only when their final results allow the launch of new pharmaceutical drugs on the market.</p>
<p>But in 2007 the United States made it mandatory for pharmaceutical laboratories to publish the results of all their trials <a href="https://clinicaltrials.gov">on a public register</a>. The European Union voted for <a href="http://ec.europa.eu/health/human-use/clinical-trials/regulation/index_en.htm">a similar ruling</a> in 2014, but it is not yet in force. </p>
<p>Despite these improvements, the results are published as simple data, not as easy-to-understand, argued and annotated publications. In addition, this progress concerns only clinical studies. As for fundamental and pre-clinical studies, there is very little out there.</p>
<h2>Ineffective or toxic molecules</h2>
<p>The disdain for negative results lead to the impoverishment of scientific knowledge, and mobilises resources (time, personnel, money) in vain. These are regrettable, but there are worse implications, too. </p>
<p>Sometimes, the fact that negative results are not published constitutes an ethical breach. In the private sector, start-ups and pharma labs are conducting cell and tissue experiments to test certain molecules, only to find that they are ineffective, or even toxic. But more often than not, even though these results would further scientific knowledge, they are not published. Without having this information, how do we know the development of these molecules is stopped?</p>
<p>We might be idealists, but we are certainly not utopians. Rather than penalising researchers who produce negative results, or pointing a finger at them, we offer them a gratifying alternative. We hope that the creation of Negative Results will help people realise interest in all results, negative as well as positive. </p>
<p>We aim to provide a database that both researchers and pharmaceutical companies can consult to optimise their research. They will thus be able to meet the expectations of society, namely to further knowledge in all the fields of biology of the living, while preserving the health and integrity of patients who agree to participate in clinical trials.</p><img src="https://counter.theconversation.com/content/68976/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rémi Thomasson works for Negative Results. He received funding from the Ile-de-France region, Labex GR-EX , and AMA (Agence Mondiale Antidopage) and AFLD (Agence Française de Lutte contre le Dopage).</span></em></p><p class="fine-print"><em><span>Antoine Muchir works for Negative Results.</span></em></p>There are good reasons why ‘negative data’ and wrong hypotheses should be made available to everyone.Rémi Thomasson, Docteur en sciences et techniques des aptitudes physiques et sportives, Université Paris CitéAntoine Muchir, chercheur à l'Institut de myologie, Sorbonne UniversitéLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/633532016-09-20T10:59:03Z2016-09-20T10:59:03ZHow poor NHS testing and antibiotic use is creating super-strength cystitis<figure><img src="https://images.theconversation.com/files/132653/original/image-20160801-17173-ddukai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Close-up of antibiotic resistant bacteria.</span> <span class="attribution"><span class="source">Kateryna Kon/Shutterstock</span></span></figcaption></figure><p>Urinary tract infections – also known as cystitis – are extremely common. Around <a href="https://www.auanet.org/education/adult-uti.cfm">150m people are affected worldwide</a> each year and one in every three women is expected to suffer at least one attack before they are 24. </p>
<p>But the real figure could actually be somewhere much higher. This is because the urine dipstick, the standard test for cystitis, has been shown to <a href="http://www.ncbi.nlm.nih.gov/pubmed/20303096">miss at least half of all infections</a>. Alongside this, the standard laboratory culture that’s used to check for bacteria in the urine also <a href="http://www.ncbi.nlm.nih.gov/pubmed/23596238">misses around 50% of all infections</a>. And if this wasn’t bad enough, around 20-30% of patients won’t respond to the “<a href="http://www.ncbi.nlm.nih.gov/pubmed/15846726">guideline treatment</a>” of antibiotics.</p>
<p>A lot of these problems can be attributed to <a href="https://www.nice.org.uk/guidance/qs90">current health guidelines</a>, which are out of date and ineffective. And the use of these “guidelines” alongside an over-reliance on poor testing methods means there is a real risk a person with a genuine urinary tract infection (UTI) will be missed and won’t receive adequate treatment. </p>
<p>This can then lead to long-term recurrent infections – and for some patients a lifetime of constant symptoms – which are made worse by sex, exercise, alcohol, certain food and drink, stress and many other of life’s normal events.</p>
<h2>Peeing problems</h2>
<p>UTIs happen when the urinary tract becomes infected, usually by bacteria. In most cases, this is bacteria from the gut, which is found in faeces – this enters the urinary tract through the urethra, the bit where wee comes out of. </p>
<p>This sounds pretty bad but it has nothing to do with hygiene or cleanliness. Anyone can get a UTI, but they’re particularly common in women, and especially common after sex. This is thought to be because a woman’s urethra is shorter than a man’s, and is closer to their anus. </p>
<p>A typical case of cystitis starts after sex, when a woman finds she needs to wee more than usual, and that going for a wee is difficult – it is slow to start and the stream is reduced. These are the <a href="http://arxiv.org/abs/1501.03537">typical early symptoms of a urine infection</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1134&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1134&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132656/original/image-20160801-17165-19hmfl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1134&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The failing dipstick test.</span>
<span class="attribution"><span class="source">Bork/Shutterstock</span></span>
</figcaption>
</figure>
<p>At this point, lots of people – even doctors – might believe the best advice is to drink plenty of water to “get things going”, but there is no evidence to justify this and it could actually make matters worse. This is because increased fluid intake dilutes the urine of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292547/">natural antibodies</a>, immune chemicals and antibiotics. Plus, the offending microbes are stuck to the bladder cells so they cannot be simply washed away.</p>
<p>As the infection progresses, it can lead to pain and burning when going for a wee and a general feeling of discomfort around the bladder. At this point, most people will go to their doctors and will have their urine tested with a <a href="http://www.bpac.org.nz/BT/2013/June/urine-tests.aspx">dipstick</a> – but given these miss at least half of infections it can hardly be considered a reliable method of testing. </p>
<h2>Ignoring the evidence</h2>
<p>Left untreated, patients often become much worse – leading to return visits to the doctor. Another dipstick test at this point might reveal there is a “trace positive result” so the urine is sent to be “cultured” at the hospital – this identifies if there are any germs in the urine that could cause a urinary tract infection. But, again because a high number of infections are missed, culturing urine is also problematic.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132654/original/image-20160801-17165-rb5i1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s a myth that cranberry juice can cure bladder infections.</span>
<span class="attribution"><span class="source">Brent Hofacker/Shutterstock</span></span>
</figcaption>
</figure>
<p>A typical treatment would now be three days of an antibiotic – which could lead to the patient feeling partially better but not cured. This happens in about <a href="http://www.ncbi.nlm.nih.gov/pubmed/15846726">20% to 30% of cases</a>, whether prescribed for three days or 14 days – but we still don’t really know why some people respond and others do not.</p>
<p>At this point, because of the limited nature of current testing methods, a urine culture may well be reported as negative and so “diagnostically” speaking the patient is declared free of infection. This is despite the continued presence of pain and tenderness when the bladder is pressed – indicating signs of infection and inflammation. </p>
<p>From here, if not treated properly, the infection might progress to a hospital admission with <a href="http://www.webmd.com/a-to-z-guides/kidney-infections-symptoms-and-treatments">a kidney infection</a>, or ongoing recurrent infections for the rest of a patient’s life. This recurrence happens because early on in the infection the responsible microbes will have organised themselves into what is known as a “<a href="https://theconversation.com/biofilms-the-bacterial-wound-communities-that-protect-themselves-from-attack-42218">biofilm</a>” which are located on the cell surfaces or inside the bladder cells.</p>
<h2>Hard to beat</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132661/original/image-20160801-17165-1g2f50l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How a biofilm develops.</span>
<span class="attribution"><span class="source">struna/Shutterstock</span></span>
</figcaption>
</figure>
<p>Biofilms are capable of protecting “delinquent microbes” from immune attack, and reduce the effectiveness of antibiotics – which is what happens in these types of bladder infections. </p>
<p>This may mean that a higher, longer dosage is needed. This goes against the current guidelines for treatment, and so is often not available to patients.</p>
<p>All of this demonstrates how we have become too reliant on tests, and imagine wrongly that they can give us clear “yes” or “no” answers to ease our doubts – they cannot. Instead, we should get back to the old clinical bedside skills that were developed years ago. </p>
<p>While I have been working in this field I have come to realise that in many cases, clinicians are using poorly equipped tests because the numerous inspectors, governors, guideline enthusiasts and dogmatists compel them to do so. This must change. We need to start scrutinising these long-held beliefs with healthy scepticism, reviewing approaches to diagnosis and patient care, because lives depend on it.</p><img src="https://counter.theconversation.com/content/63353/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Malone-Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Poor testing methods and antibiotic use by GPs and urologists has left thousands of women with crippling infections.James Malone-Lee, Professor of Medicine, Whittington Campus, UCL Medical School, UCLLicensed as Creative Commons – attribution, no derivatives.