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Bacteria and Biofilms in UTI

Hannah Helgeson

If you’ve experienced more than one UTI it’s probably clear to you that the infections can be persistent and hard to get rid of. Antibiotic regimens are usually the go-to treatment for any kind of UTI, but they can have mixed to poor success with actually eradicating the infection. This is especially true when it comes to recurrent or chronic UTI.


You may wonder what causes chronic and recurrent urinary tract infections to be so hard to treat compared to acute infections. This has to do with a seldom discussed process that happens with bacteria on the cellular level. Here, we will cover the science of embedded bacteria and biofilms and the reason why chronic and recurrent UTI remain so hard to treat.


Embedded Bacteria

It’s important to establish that there are persistent myths about urinary health. A major myth that many people believe to this day is the idea that urine is sterile. This is not at all true and has been strongly proven otherwise. In fact, there are hundreds of bacteria in every bladder, forming a complex bacterial habitat known as the urobiome. This is normal, and plenty of these microbes can even be beneficial when in appropriate balance.


Urinary tract infections begin when unwanted pathogens, such as E. coli, invade the urobiome. Pathogens can cross into the urinary tract for many reasons, such as sexual activity, hospital infection, or often even factors entirely outside of the patient’s control, like anatomy. 


Once these pathogens swim through the urethra up into the bladder, they begin the process of quite literally penetrating down into the bladder wall. We call this process intracellular colonization, and it is one of the key ways that UTIs are so hard to treat. This is because rather than the harmful bacteria continuing to float around in the bladder, these pathogens bury themselves layers deep into the bladder lining. Once the bad bacteria is embedded within the bladder, normal antibiotic treatment is no longer sufficient to get rid of the infection. Not only that but once the colonization has begun, the bladder begins to become inflamed, causing worsened symptoms. 


Formation of Biofilms

But what are biofilms? Biofilms are a substance of combined microbes that have joined together to form a wall-like layer that rests on top of cells. They are created when bacteria secrete a slimy membrane, which ends up cultivating a community of bacteria in a viscous material. It’s important to note that biofilms are not inherently harmful on their own. Rather, they are a natural part of our body and not problematic in themselves.


It’s only when biofilms come into contact with bacteria that biofilms can become detrimental. When disease comes in contact with biofilms two things can happen that help the infection persist. The first is that the bacteria cells may stop dividing. When the bacteria enter this state, they are significantly more resistant to antibiotic treatment. Another possibility is that the biofilms further cement the harmful bacteria to the cells. The result is that the barrier-like surface of biofilms ends up trapping the harmful bacteria, making it nearly impossible to treat.  Harmful bacteria are then able to hide within the closed substance of the biofilm, making it able to avoid the reach of not only antibiotics but the body’s natural defense mechanisms as well. 


Once in a biofilm, bacteria can use chemical molecules to signal to each other and form a group survival plan. This process is known as quorum sensing. Once bacteria are embedded, they carry an antibiotic resistance that is estimated to be 10 to even up to 1000 times more prominent than antibiotic resistance within planktonic–or free-floating–bacteria. 


Biofilms are one of the most prevalent reasons why UTI can become recurrent or chronic. They are also the main culprit behind CAUTI, or catheter-associated urinary tract infections, which are especially prominent within hospitals. Catheter-associated urinary tract infections are one of the most common healthcare infections, and it is estimated that over 13,000 deaths annually can be attributed to CAUTI. Biofilms are highly associated with CAUTI-associated infections and are known to block the catheter itself. Catheters are more likely to develop biofilm communities, which in turn perpetuate the infection. People living with catheter-associated urinary tract infections are an underspoken group that often takes the brunt of this infection.


Closing Thoughts

Much more research is needed on biofilms and their role in chronic and recurrent UTI. Particularly, as biofilm communities are resistant to antibiotics, it can be extremely challenging to find an effective treatment for these bacteria once the biofilm has formed.


Early intervention and rigorous antibiotic treatment before the infection is able to form biofilms tend to be the best plan of attack. However, for many people with UTI, catching the infection early is simply not possible. That being said, there are a few treatments that have been known to potentially help with biofilm dissipation. 


Some people have found help through “biofilms busters,” i.e., specific supplements designed to break down biofilms and promote microbial health. More studies need to be done into this method, but for those wanting a natural solution, this may be worth trying.


Another potential treatment undergoing scientific research is quorum-sensing inhibitors. This developing regimen uses bioactive molecules to “quench” the quorum sensing system that biofilms rely on to communicate and strengthen each other. Natural and synthetic compounds have both been used in the inhibition of biofilms. While some success has been found with this treatment, more studies must be done.


A potential alternative is bacteriophage therapy. Phage therapy has been used in other parts of the world as an antibiotic alternative with success for decades, but it remains near impossible to access in the Western world. However, it is something to keep an eye on and hope change happens around, as phage therapy is a potentially great alternative to antibiotics.


There is no simple cure-all when it comes to UTI. This is especially true when mechanisms like biofilms allow the condition to progress into recurrent or chronic status. That’s why being your own greatest advocate is crucial when seeking treatment for your UTI. You have the right to have your symptoms acknowledged and taken seriously.


Change around how UTI is treated must happen sooner rather than later in our medical system. UTI is the most common outpatient infection and affects 404 million people annually, but the protocols around testing and treating it have fallen behind. By working together we can make a change. Our prerogative is to shine a light on the many issues around UTI, to foster research and education, and to give patients a voice. We sincerely hope you join us on this journey.

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