Food Contamination, at Root of Urinary Tract Infection

Food Contamination at Root of
Urinary Tract Infection

San Jose Mercury News
October 4, 2001
Study: Food contamination at root of drug-resistant urinary tract infection

By Lisa M. Krieger

SAN JOSE, Calif. _ Food contamination is believed to be the culprit
behind an epidemic of painful urinary-tract infections that are resistant to
conventional treatment, according to a startling new study by University of
California-Berkeley scientists.

Three far-flung clusters of U.S. university students were found to be
infected with nearly identical strains of drug-resistant E. coli bacteria,
the scientists report in the current issue of The New England Journal of

While the origins of this newly-identified "superbug" remain a mystery,
scientists say they believe it was transmitted through food because it was
found almost simultaneously on campuses as far away as Berkeley, Calif.,
Minneapolis and Ann Arbor, Mich. _ and looked genetically similar in each
locale, suggesting it had just arrived and had not had time to evolve.
"This became a rapidly emerging problem; it was not a gradual process,"
said epidemiologist Dr. Lee W. Riley of the UC-Berkeley School of Public
Health. "The only way that could happen is through the introduction of some
nationally-distributed food product."

The scientists found that 22 percent of urinary-tract infections at the
campuses were resistant to a drug called trimethoprim-sulfamethoxazole
(TMP-SMX), the first line of therapy, as well as other antibiotics. Of
these drug-resistant infections, half were caused by a previously
unrecognized strain of bacteria.

For the past decade, doctors have been warning that diseases that were
once easily cured are now stronger than their medicines. Drug-resistant
bacteria are typically created through the excessive use of antibiotics.
These bacteria are usually spread in hospital settings.

The current outbreak, another unsettling example of the resistance trend,
is especially worrisome if resistance was acquired by simply eating food
that had been contaminated by the superbug.

In an editorial that accompanied the study, Dr. Walter E. Stamm of the
University of Washington School of Medicine in Seattle, urged "a much
more aggressive approach to the control of anti-microbial resistance."

"The emergence and spread of resistance among E. coli that cause
urinary-tract infections represent yet another example of the ongoing
global problem of anti-microbial resistance," he wrote.

E. coli exists normally in the intestinal tract and is essential to
digestion. But if it migrates up into the urinary tract, it causes painful
infection. If untreated, it may travel up into the kidneys, creating

This new type of E. coli poses a greater treatment challenge because it is
resistant to trimethoprim-sulfamethoxazole (TMP-SMX), a first line of
therapy. After two to three days of treatment with these drugs, symptoms
remain because the bacteria has not died. However, it is usually still
susceptible to at least three other drugs, such as fluoroquinolone,
ciprofloxacin and nitrofurantoin.

Interestingly, the study of several hundred UC-Berkeley students was able
to detect resistant bacteria in the intestines of students who did not have
urinary tract infections _ probably due to contaminated food they had
eaten, said Riley.

Urinary tract infections, called cystitis, are the most common infection in
women, affecting two out of three women at some point in their lives. It is
estimated that there are at least 300 million cases of urinary tract
infections worldwide each year.

Infections can recur, and at least a third of women with an infection
experience another within a year. If untreated, they can lead to far
dangerous infections in the kidneys and blood. Cystitis is more common
in women than men, due to differing lengths of their urethras.

The E. coli that caused the urinary tract infections in this study is a
less dangerous cousin to the one that was transmitted on Jack In The Box
hamburgers in the early '90s, killing several people and sickening hundreds.

"The next step is to find out where it came from," said Riley.

The team will inquire into the diets of students, then trace back the
source of their foods _ even testing farm animals, if necessary. They also
will look for the bacteria in members of the general population, to see how
widespread it is.

To prevent infection, Riley suggested common-sense precautions, such as
washing hands, fruits and vegetables for eating. He recommended cooking
meat well and seeking medical care if a urinary tract infection does not
respond to treatment within several days.

"If a large proportion of urinary tract infections caused by E. coli are
due to ingestion of foods, that would constitute a serious and novel public
health problem," said Riley.

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