Resistant and recurring infections

What is a resistant infection?

The CDC describes antimicrobial resistance as germs developing the ability to defeat the drugs meant to kill them. The germs that survive keep going. The CDC says a resistant infection can make treatment and recovery longer, sometimes by months. Resistance belongs to the germ, not to the patient’s body.

In its fact sheet, WHO says that misuse and overuse of antibiotics are among the main drivers of this problem. Lack of clean water and sanitation, weak infection control at home and in healthcare facilities, and limited access to vaccines and testing are also on its list. The CDC adds that a resistant germ can pass its resistance to other germs, and can travel from country to country with people who travel.

“Recurring” is not the same as “resistant”. An infection that comes back may still be sensitive to the earlier drug, and the cause may lie elsewhere, for example a focus of infection the treatment did not reach. So the first job is to work out which of these has happened in your case.

Who should be seen?

• Someone who has taken one or more courses of antibiotics and is no better, or whose infection returned after a few days.
• Someone whose culture or antibiogram result says “resistant”.
• A patient with repeated urinary infections. The NHS defines this as two in six months or three in twelve months.
• Someone who caught an infection after a hospital stay, an operation, or treatment in another country. The CDC advises telling your doctor about travel and treatment abroad.
• A patient with diabetes, weakened immunity, or a catheter, in whom an infection becomes serious sooner.

How is it investigated?

Your story. The medicines you have taken, the dates of each course and how you responded, trips and treatment abroad, contact with hospitals, and any device inside the body (a catheter, a prosthesis, screws and plates). The medicine box or the prescription helps.

Examination and tests. The doctor assesses your symptoms and, depending on where the infection is, asks for tests and imaging.

Culture. MedlinePlus says the type of sample depends on the site of infection: blood, urine, sputum, a wound or stool. The laboratory grows the bacteria in a dish so they can be identified. Most bacteria take one to two days, and some take five days or more.

Antibiogram. Once the bacteria are identified, they are tested against several antibiotics. The result is usually reported as sensitive, intermediate or resistant. What this report means, and why you should not pick a medicine from it yourself, is explained in the article What is an antibiogram?.

What does treatment look like in general?

• The medicine is chosen using the test results. The aim is a medicine suited to this germ at this site, not the strongest medicine. MedlinePlus says that if a germ resists every medicine tested, sometimes several medicines are needed together.
• Resistance makes treatment harder. The CDC says second- and third-line medicines may cause serious side effects and can be costly.
• The focus of infection also needs to be dealt with. If the infection is somewhere the medicine does not reach well, or there is a device in the body, something besides medicine may be needed. That decision is the doctor’s.
• The doctor decides how long treatment lasts. Do not stop the medicine halfway without the doctor’s opinion, and do not change it yourself.

What can you do yourself?

• Bring your medicine records and earlier test results, and write down the order in which you took the medicines.
• Do not use leftover antibiotics or other people’s medicine. The CDC says not to save antibiotics for later, and the NHS says not to borrow other people’s.
• Do not ask for antibiotics for a virus such as a cold. The CDC reminds patients not to pressure their doctor.
• If you get a side effect such as diarrhoea while taking an antibiotic, the CDC says to tell your doctor.
• Wash your hands regularly. See also the guide on taking antibiotics the right way.

When to act urgently

An infection can progress to sepsis. If you notice confusion, fast breathing, pale or bluish skin, shivering you cannot control, or a rash that does not fade under pressure, look at the list of urgent signs and call 115, Iran’s emergency number.

For a urinary infection, the NHS says to act urgently if the patient becomes confused or drowsy, or has trouble speaking. If a urinary infection also brings fever, chills or pain in the back just under the ribs, it may have reached the kidney. The NHS says a kidney infection can be serious; see a doctor the same day. The NHS says to get an urgent appointment if the patient is aged 65 or older, is a child aged 15 or younger, has diabetes, is male or pregnant, has a weakened immune system or a catheter, and also whenever symptoms get worse quickly or do not improve within 48 hours of starting treatment.

This page is for information only and does not replace an examination.