The Patient Who Finally Knows Why Her UTIs Won’t Go Away

Nanell Mann began getting urinary tract infections in 1971, when she got a hysterectomy following the birth of her sixth child. She would take antibiotics and get better. Get sick again. Take antibiotics. Not get better. Take other antibiotics. Repeat, repeat, repeat for more than 40 years—the list of treatments that worked against her infections getting shorter and shorter and shorter over time. Her UTIs became resistant to multiple antibiotics. And she kept getting sick.

Now her recurrent UTIs are so frequent and so difficult to treat that she has to plan her life around them. “I know every bathroom in every place I shop,” Mann, who is 82 and lives outside Salt Lake City, told me. She tries not to go anywhere she doesn’t know, because UTIs can lead to frequent and intense urges to urinate, along with pain, fatigue, headaches, and sometimes even a deadly infection of the kidneys.

Mann’s case might be remarkable for its duration, but she is part of a growing and worrying trend: More and more UTIs are becoming resistant to antibiotics. And in these cases, doctors are finding it difficult to treat what were once easily cured infections. “They kind of give up on you because they don’t know what to do,” Mann said. She was frustrated and desperate and in pain.

In 2012, Mann got in touch with Matt Mulvey, a microbiologist at the University of Utah. Mulvey had published a few papers on bacteria that cause UTIs, and patients were frequently emailing him for help. “I always feel bad,” he says, “because I feel very unable to help them.” But Mann was unusually persistent—as well as unusually nice, Mulvey says—and the relationship turned into a multiyear, single-patient study. Over a period of five years, Mulvey and his collaborators collected and sequenced urine samples from Mann when she got UTIs.

All of Mann’s UTIs during that five-year period turned out to originate from a single strain of E. coli known as ST131, commonly found in drug-resistant UTIs. But where was Mann getting the same strain from over and over again? The team decided to sequence Mann’s fecal samples too, and found a match: The bacteria causing her UTIs were also hiding out in her gut.

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