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Intravesical Gentamicin Treatment for Recurrent Urinary Tract Infections Caused by Multidrug Resistant Bacteria
Janneke E Stalenhoef1, Cees van Nieuwkoop2, Petra H Menken1
1Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
Purpose:
Antimicrobial resistance leads to complications in the management of recurrent urinary tract infections. In some patients with recurrent urinary tract infections who have limited treatment options intravenous therapy with reserve antibiotics is often required. In this study we assessed the effectiveness, safety and feasibility of prophylactic treatment with intravesical gentamicin in patients with refractory recurrent urinary tract infections caused by multidrug resistant microorganisms.
Materials And Methods:
This was a prospective trial of 63 adults with recurrent urinary tract infections caused by multidrug resistant pathogens who were enrolled at 1 academic and 1 general hospital in The Netherlands between 2014 and 2017. The intervention was overnight intravesical instillations of gentamicin for 6 months. The primary outcome was the recurrence rate of urinary tract infections compared to that in the preceding 6 months. Secondary objectives included assessment of the safety of intravesical gentamicin instillation and its influence on the development of antibiotic resistance in uropathogens.
Results:
The mean number of urinary tract infections was reduced from 4.8 to 1.0 during intravesical treatment. The resistance rate of the uropathogens decreased from 78% to 23%. No systemic absorption or clinically relevant side effects were observed.
Conclusions:
Intravesical gentamicin instillation reduced the number of urinary tract infection episodes and the degree of antimicrobial resistance.
Insights
Prophylactic intravesical gentamicin significantly reduced recurrent urinary tract infections and antimicrobial resistance in patients with multidrug-resistant pathogens. This treatment was safe and feasible, offering a new option for refractory cases.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Recurrent urinary tract infections (rUTIs) pose management challenges due to antimicrobial resistance.
- Limited treatment options for refractory rUTIs often necessitate intravenous reserve antibiotics.
- Multidrug-resistant (MDR) pathogens complicate rUTI treatment.
Purpose of the Study:
- To evaluate the effectiveness, safety, and feasibility of prophylactic intravesical gentamicin for refractory rUTIs caused by MDR microorganisms.
- To assess the impact of intravesical gentamicin on UTI recurrence rates.
- To determine the influence of this treatment on uropathogen antibiotic resistance.
Main Methods:
- Prospective trial involving 63 adults with MDR rUTIs.
- Intervention: Overnight intravesical gentamicin instillations for 6 months.
- Primary outcome: Reduction in UTI recurrence rate compared to the previous 6 months.
Main Results:
- Mean UTI episodes decreased from 4.8 to 1.0 during treatment.
- Uropathogen resistance rates dropped significantly from 78% to 23%.
- No systemic absorption or clinically relevant side effects were reported.
Conclusions:
- Intravesical gentamicin instillation is effective in reducing UTI episodes.
- This treatment also decreases the prevalence of antimicrobial resistance in uropathogens.
- Intravesical gentamicin offers a safe and feasible therapeutic option for refractory rUTIs.
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