Research aims to shed light on chronic UTIs

A new database on chronic urinary tract infections aims to help explain why millions of women and girls worldwide develop persistent infections that can defy treatment.

A growing body of research suggests persistent, antibiotic-resistant UTIs may be caused by bacteria that embed deep within the bladder wall, potentially evading both the immune system and conventional treatments.

This phenomenon, known as intracellular bacterial colonisation, means bacteria live inside cells rather than on their surface.

While it is not new, a medical case study of a child with chronic infections, led by University of Sydney researchers, suggests its long-term impact may be underestimated.

The case study found no antibiotic regimen, including aggressive long-term courses, could eliminate the infection because bacteria were embedded in the epithelium, the bladder’s inner lining.

Samples showed no improvement despite years of treatment, raising concerns about current approaches, which remain limited to antibiotic therapy and diathermy, a surgical technique using heat from an electrical current to cut or coagulate the bladder lining, and which carries an increased risk of cancer development if performed repeatedly.

Lead researcher Dr Arthika Manoharan, from the Charles Perkins Centre and the School of Medical Sciences, said some girls as young as five are treated with antibiotics for years, often relapsing as soon as treatment stops.

As a result of the published case study, children under 15 will be the focus of the new database built by Dr Manoharan, which aims to understand why some people develop chronic UTIs.

She said she hopes it will help remove the long-held assumption that UTIs are linked to sexual activity.

She said: “Often people think of UTIs only affecting adult women who are sexually active, which is not the case.

“There are many cases where this issue starts in childhood, with no clear cause.

“This can have a huge impact to their quality of life at a time when they should be enjoying school, playing sports and simply being kids.

“The longer consequences of persistent UTIs can be severe.

“Some women see their employment affected due to chronic incontinence; others are unable to maintain a sexual relationship.

“Many echo the same sentiment: One minute you’re fine, the next you’re in agony and can’t leave the house.”

The research team said it hopes the database will help explore whether immune system evasion or genetic predisposition could explain why some children develop chronic UTIs while others do not.