Published Case Study

 

Case Study: Resolution of a Recurrent, Antibiotic-Resistant UTI

Metagenics Update Professional Journal
http://www.metagenics.com.au

Case Presentation

A persistent infection can be stressful, debilitating and hugely inconvenient. This was the case for the 50 year old female who presented to Naturopath, Catherine Walker, with a history of urinary tract infections (UTIs), including a current UTI of five months duration. Her symptoms included low back pain, urinary urgency, digestive discomfort, exhaustion and emotional distress. Her dysuria and urinary urgency left her reluctant to go out, creating social isolation where previously she had been active, ‘confident and happy’. In the preceding five months the patient had been prescribed three separate antibiotics with no resolution. A recent mid-stream urinalysis (MSU) tested positive for Escherichia coli and the presence of blood, and the patient was diagnosed with antibiotic-resistant UTI. Hospitalisation was advised by her GP to avoid kidney damage, and a nephrologist and urologist referral issued with a view to further testing. Resigned to accept her situation, the patient presented to the Practitioner at her friends encouragement, reluctant to proceed with hospital or specialist services. An in-clinic urinary test was performed at the initial visit that tested positive to blood and protein, suggestive of compromised kidney function.

Treatment Plan

The Practitioner developed a holistic treatment plan (Table One) aimed at eliminating the current infection, addressing the suspected concomitant gastrointestinal tract (GIT) microbiota imbalance, and enhancing immune function. In addition, the patient was given lifestyle recommendations to reduce future UTI risk, including increasing water consumption to a minimum of two litres per day.

Clinical Outcomes

Within one week the patient reported feeling ‘quite a bit better’ and despite her initial misgivings, was now feeling more hopeful and optimistic. She noted an increase in energy and described a 75 percent reduction in low back pain and urinary urgency. This positive outcome motivated her to continue treatment and by week three she was walking her dogs and socialising again without concern of urinary urgency. A repeat in-clinic urine test remained positive for blood but negative for protein indicating an improvement in renal function. The Practitioner decreased the frequency of the Chinese Herbal support for Urinary Disturbances to a maintenance dose and requested a follow-up MSU to check progress. At week five the patient reported her MSU was now clear of infection for the first time in six months. She was very happy with the treatment outcomes with no symptoms of dysuria, only minor urinary incontinence and a reduction in GIT discomfort. By week eight the patient described ‘feeling very well’ with no urinary symptoms remaining and her in-clinic urine test was now negative. She had recommenced her voluntary work and was feeling optimistic and empowered. At this point all supplements were stopped other than the Immune Enhancing Probiotic, deemed necessary for ongoing maintenance.

Prescription Rationale
Chinese Herbal Support for Urinary Disturbances Concentrated traditional Chinese herbs to relieve and manage urinary disturbances including sensations of pain and burning.
Nutritional Support for the Kidneys Traditional Western herbs including 3.0 g cleavers along with 1.1 g bearberry per dose, to support kidney and bladder health and enhance urinary waste elimination.
Immune Enhancing Probiotic L. acidophilus (NCFM®), B. lactis (HN019) and L. rhamnosus (HN001) indicated in recurrent infections to promote cellular immune response, support GIT health and help maintain a healthy immune system.
Zinc with Vitamin C Powder Foundational immune supporting nutrients including therapeutic doses of zinc and vitamin C.
Topical probiotic A probiotic used intra-vaginally to help restore local microbiota balance.
Table One: Holistic Treatment Plan

Discussion

Any chronic infection is debilitating, however when accompanied by ongoing pain and dysfunction that impacts simple everyday tasks and pleasures, as a UTI can do, then a persistent infection becomes a life-altering event. It can degrade quality of life leading to poor mental health and outlook. A priority in these instances is offering rapid symptomatic relief to raise vitality, whilst identifying and addressing any related factors, such as the likelihood of dysbiosis in a recurrent UTI case, therefore the need to correct GIT microbiota imbalance.

In this case, the Practitioner gave rapid symptom relief by prescribing the combination of Chinese Herbal Support for Urinary Disturbances and Nutritional Support for the Kidneys, motivating the patient to commit to treatment. Lycopodium japonicum is traditionally used as a urinary astringent and antiseptic,1 making it ideal for relieving symptoms of UTIs such as urinary irritation, dysuria and haematuria. Additional antimicrobial properties offered by Smilax china assist to relieve the pain associated with UTIs,2 by addressing the underlying infection. The traditional Western herb Galium aparine also supports the urinary elimination of wastes,3 necessary in any infective situation for healing to occur.

Up to 90 percent of UTIs are caused by E. Coli originating from the bowel, as it can migrate easily to the urethra, causing a spectrum of genitourinary complaints.4 As the risk of reinfection is high, lending itself to recurrent UTIs, rebalancing the microbiota with strategic probiotic therapy helps target the underlying microbial insult. The specific probiotic strains Lactobacillus acidophilus (NCFM®), Bifidobacterium lactis (HN019) and Lactobacillus rhamnosus (HN001) demonstrate high adherence to intestinal epithelial cells.5 This increases the number of beneficial bacterial species within the GIT that enhance the immune system,6 as well as promoting an environment conducive to keeping pathogenic species in check. Interestingly, the strains HN019 and HN001 have both demonstrated protective characteristics against E. coli in murine models,7,8 which may explain the particular success of this combination in UTI cases. In this particular case, a further key strategy was the specific advice offered to the patient such as hydration and good hygiene practices as these have an additive effect, helping to minimise exposure to pathogenic bacteria.

This case is a good example of how combining an effective prescription with appropriate education can work promptly to address even the most challenging cases, offering patients a positive outcome and the tools to manage their health in future.

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