Is Intravesical Gentamicin the New Gold Standard to Manage Refractory Urinary Tract Infections?-Experience From a...

To assess the effectiveness of intravesical gentamicin in managing recurrent urinary tract infections (rUTIs) refractory to first- and second-line treatments.

This single-centre prospective cohort study included 41 patients treated with intravesical gentamicin over a 24-month period from 2021 to 2023. A multidisciplinary team comprising functional urologists, microbiologists, and specialist nurses was involved in the decision-making process and in designing the treatment protocol. Patients self-administered gentamicin instillations into the bladder according to a 6-month instillation schedule. Patients were followed up during and after the treatment period to assess the treatment response.

A total of 41 patients with rUTIs were treated using the 6-month intravesical gentamicin regimen. Of these, 10 were male and 31 were female, with a mean age of 53 years. E. coli was isolated from urine cultures in 19 patients (46%), while 19 patients had multiple organisms. Serum gentamicin levels were undetectable in all patients 1 week after treatment initiation. The mean follow-up period was 15 months with minimum follow up of 6 months for all patients. Following gentamicin administration, hospital admission rates due to urosepsis decreased from 46% to 5%, and the prevalence of multidrug-resistant organisms in urine cultures decreased from 44% to 10%. A significant reduction in UTI frequency was observed in 80.5% of patients, with 71% reporting good to excellent Patient Global Impression of Improvement (PGI-I) scores. Additionally, 76% of patients reported a significant improvement in Quality of Life (QoL).

In our cohort of patients with recurrent and refractory UTIs, intravesical gentamicin instillations has shown to be both safe and effective, leading to notable improvements in patients' symptoms and QoL.