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Understanding repeat E.coli related cystitis, bladder infections, and UTI's.(Go to short version) (Printable Version)We have learned a lot from our customers and from our
own experiences and research about the causes of repeat urinary infections,
particularly related to E.coli, and the results are interesting for anyone
who wants to learn how to avoid such infections. Clearly, there must be a first time for such contamination and infection, but in the vast majority of cases, (though not all) apparently repeat infections are the result of E.coli that survived the previous infection, and have been dormant in the bladder [Proof!] until stimulated into releasing pods from their colony to once again multiply out of control. E.coli are uniquely adapted super mutators. E.coli survive antibiotic attackThere is good evidence for this, although not many doctors appear to have taken it on board yet (from the number of women who tell us that their doctor keeps lecturing them on personal hygiene.) When you actually sit down and think about the pattern of most repeat infections, logic leads you to the same conclusions. Darwin'sSurvival of the Species through Natural Selection explains the process through higher forms of life, and E.coli survives as a life form in the same way that we have evolved as humans - by survival of the fittest. Every medical practitioner and every cystitis sufferer
knows that E.coli become increasingly resistant to antibiotics used against
them. It is important for the understanding of how antibiotic resistance
takes place to realise that it's not your body that builds up a resistance
to antibiotics, it is the infection agent - in the case of bladder infections,
usually E.coli. Asexual Survival Characteristics (E.coli)Say you start off with a strain called x... If you kill all of x with an antibiotic, then there are no x survivors, and if you were to again be infected with x (as a fresh contamination), and took the same antibiotic, there could be no increase in the resistance of x. It would be just like the first time, and they would be all killed. But this is where natural selection comes in. E.coli are asexual organisms with natural variation in the genetic makup of some of the bacteria in every colony. In effect E.coli are genetic clones of each other, but there are occasional mutations that produce genetic variation, giving the variation different survival capabilities. For example, although some of the mutations will have poor survival capabilities, some E.coli in every colony may be able to survive unusual heat, cold, toxin levels, antibiotic attack, or high acidity or alkalinity. They pass on these survival characteristics to their progeny. Doctors attempt to fight the resistance of E.coli by
varying the antibiotics used, and by increasing antibiotic dose levels
to compensate for the resistance effect, but this only exasperates the
problem as the E.coli become increasingly resistant, even to broad-spectrum
antibiotics. The result is seriously resistant E.coli that only something
that defeats the E.coli in another way (like Waterfall D-Mannose) can
get rid of from your body. Variant E.coli and Antibiotic ResistanceThe mechanism of E.coli antibiotic resistance is that one or more natural E.coli variants, (lets call it variant xy), survives the antibiotic attack. For example, by not succumbing to fluorine poisoning. So the antibiotic kills off all x colonies, and xy is left to multiply and establish colonies of it's own, passing on its resistance to fluorine (or whatever toxin the antibiotic utilised) to its duplicates. Most of the xy colonies will be xy type variant, and we already know that xy variant can survive the antibiotic that killed all its x brothers. It's a born survivor. You can't use what you used to kill x, to kill xy - at least not at the same dose levels or not for the same treatment length. So you'll need a longer course of antibiotics or at a stronger dose level to kill xy. And don't forget, xy will have its own variants. Somewhere, there will be an xz variant that can survive these bigger doses. Lets look at the logic again: We know for a fact that E.coli builds up resistance to any antibiotic used against it. It can only do that if some of the bacteria survive the antibiotic attack. If your second episode of cystitis is simply a fresh contamination of the same E.coli that you were previously contaminated with, we are not talking about mutated survivors of the antibiotic, we are talking about the plain old original bug again, so the same dose level of the same antibiotic will work as well as it did before. However, that is not how the course of repeated cystitis attacks works. Typically, infection becomes more and more frequent. Patients go back for more antibiotics. Doctors find that the same dose level doesn't work, so they increase the dose levels, and increase the number treatment days. Or they vary the antibiotic. Gradually, they have to move on to big hitting fluorotoxins like Ciprofloxacin. See Business Week Cipro: Now for the Downside Thus, increasing resistance could not happen if the cystitis were the result of fresh E.coli contamination of non-resistant bugs through faecal contamination or introduced through a sexual partner, or by any other route. Resistance occurs because of survival of the fittest - survival from a previous contamination. Logic therefore tells us that resistant E.coli is left in the bladder after treatment with antibiotics. Fact tells us that it's detectable six weeks later in 35% of women. A year later it has recurred in half of all antibiotic treated women.
Less detectable, but still present, are E.coli living
behind biofilms in the bladder, because they don't show up in urine tests.
[Proof!] Implications and AvoidanceFrom the fact that if you are suffering from repeat episodes of cystitis, E.coli are probably living in your bladder, dormant or not, it is apparent that it is more difficult to avoid than it would be if the problem were simply cross-infection, or poor hygiene. And anyway, once you've had an episode or two of cystitis you'll be obsessively clean. What we've found is that there can be a number of triggers that lead to the next episode - a number of triggers that lead to the reactivation of dormant E.coli already in the bladder, or the release of E.coli pods from behind biofilms in the bladder (the biofilms are made of the same stuff as your bladder wall.) The triggers for dormant E.coli release and causes of fresh contamination also differ, although there is some crossover. Whatever caused that very first infection, it is what makes new or apparently new that is important to sufferers. Triggers for dormant E.coli release:
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