Residents at risk of UTI complications as aged care antibiotic resistance increases

Clinicians are being urged to consider the best approach to treating urinary tract infections (UTIs) in residential aged care after researchers from UNSW Sydney discovered antibiotic resistance in treating UTIs is highest in residential care settings. 

Key points

• In Australia, UTIs account for roughly 1.5% of all General Practitioner (GP) consultations; the equivalent of 2.62 million GP visits every year
• UNSW Sydney researchers found that UTIs caused by E. coli from aged care homes show higher resistance to antibiotics compared to cases collected from hospitals and the wider community 
• Meanwhile, antibiotic resistance in UTIs was reduced during the COVID-19 pandemic
• Adelaide University researchers have also uncovered increasing levels of antimicrobial resistance, including in wastewater samples from aged care homes and retirement communities

As one of the most prominent infections, UTIs can have a drastic impact on the everyday lives of Australians, including older Australians, explained UNSW PhD candidate and report co-author Alex Young. 

“Infections are really common, but are particularly frequent in women and older people,” Ms Young said.

“The typical symptoms are frequency and urgency to urinate and pain when urinating. In a severe situation, the bacteria can travel up from the urinary tract and into the kidney, where it may transfer into blood and cause sepsis, which is very serious.”

Research shows that by the age of 24, nearly one in three women will have already had at least one episode of UTI that requires antimicrobial therapy, which can be one factor contributing to longer-term antibiotic resistance.

Ms Young, alongside Associate Professor Li Zhang and their collaborators, analysed the antibiotic resistance of almost 800,000 UTI samples from across New South Wales. These samples were collected from GP clinics, hospitals and aged care homes before and during the COVID-19 pandemic.

Overall, Ms Young said resistance to the standard course of antibiotics given in Australia – trimethoprim – was high. E. coli had a high resistance rate of between 20-30%, depending on the clinical setting. 

“Generally, a resistance rate higher than 20% would be cause for concern. Societies in Europe and America have identified a 20% resistance rate as the cutoff for effective trimethoprim therapy,” A/Prof. Zhang added.

However, it was among aged care settings where the rates were highest, and Ms Young suggested that increased infection control during the COVID-19 pandemic was a contributing factor as resistance rates reduced from 2020 to 2022.

“E. coli resistance to trimethoprim was highest when you look at infections within the aged care setting, followed by hospitals, then the community,” she said.

“In hospitals and aged care, there’s a much higher chance of being able to catch a very resistant infection from that environment because there’s a lot more resistant bacteria around as well as people who are generally unwell and less likely to be able to fight an infection.”

Although they have hypothesised that COVID-19 infection control measures have had an impact, it is unclear as to where aged care residents have picked up different pathogens that are highly resistant to treatment. Determining what exactly is contributing to trimethoprim resistance is the next step for researchers.

“Is it because older people in aged care facilities have visited hospitals and acquired the resistant UTI there? Or is it because antibiotic resistant strains are circulating in the aged care facility itself?” A/Prof. Zhang queried. 

“The more we know, the better we can devise strategies to control or reduce this antibiotic resistance.”

With increased rates of resistance against a common infection that can quickly turn serious if not treated efficiently, the team from UNSW Sydney wants to see clinicians and policymakers evaluate more effective treatment options. Ms Young said antibiotic resistance is a key consideration when making treatment recommendations that can impact quality of life.

“As well as affecting older people, the burden of UTIs also falls heavily on women. UTIs can have a huge impact of people’s health and quality of life, so it’s important that challenges like antibiotic resistance are addressed,” she added.