Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization

Abstract

Introduction: This study aimed to determine if gentamicin bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in neurogenic bladder (NGB) patients on intermittent selfcatheterization (ISC) who have recurrent UTIs. Secondary aims were to examine the effects of intravesical gentamicin on the organism resistance patterns. Methods: We retrospectively reviewed our prospective NGB database. Inclusion criteria were NGB patients performing ISC exclusively for bladder drainage with clinical data available for six months before and six months after initiating prophylactic intravesical gentamicin instillations. Symptomatic UTIs were defined as symptoms consistent with UTI plus the need for antibiotic treatment. Results: Twenty-two patients met inclusion criteria; etiology of NGB was 63.6% spinal cord injury, 13.6% multiple sclerosis. Median time since injury/diagnosis was 14 years and 6/22 (27.3%) had undergone urological reconstruction. Patients had fewer symptomatic UTI's (median 4 vs. 1 episodes; p<0.004) and underwent fewer courses of oral antibiotics after initiating gentamicin (median 3.5 vs. 1; p<0.01). Days of oral antibiotic therapy decreased from 15 before to five after gentamicin, but this did not reach significance. There were fewer telephone encounters for UTI concerns per patient (median 3 vs. 0; p=0.03). The proportion of multidrug-resistant organisms in urine cultures decreased from 58.3% to 47.1% (p=0.04) and the rate of gentamicin resistance did not increase. Adverse events were mild and rare. Conclusions: Gentamicin bladder instillations decrease symptomatic UTI episodes and reduce oral antibiotics in patients with NGB on ISC who were suffering from recurrent UTIs. Antibiotic resistance decreased while on gentamicin instillations.

Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

“…The mean age participants in the included studies were 52 years with a male to female ratio of 1:1 (Table 1 ). Although majority of studies (7/11) used gentamicin as the IVA, this included 3 where it was used as treatment and 4 where it was used a prophylaxis against rUTI [ 2 , 4 , 5 , 8 ••, 9 , 10 •, 11 ]. The other IVA used were a combination of neomycin/polymyxin ( n = 2) and isolated neomycin and colistin in one study each [ 1 , 3 •, 6 , 7 ].…”

Systematic review and practice policy statements on urinary tract infection prevention in adults with spina bifida

“…No RCT was identified that addressed the use of gentamicin to prevent UTI in NB patients. A single retrospective quasi-experimental study assessing 22 patients with NB before and after the use of intravesical gentamicin found patients used less oral antibiotics after gentamicin instillations were initiated, had fewer symptomatic UTI’s and fewer courses of UTI treatment ( 22 ). Another retrospective study of 80 children (54 with NB) assessed intravesical gentamicin for UTI refractory to two courses of oral antibiotics or had asymptomatic Pseudomonas or Proteus bacteriuria.…”

Voiding conditions, renal and bowel function in a cohort of adults with spina bifida

“…This will hopefully further diminish since studies have shown that recurrence of infections occurs despite taking prophylaxis 15 . New strategies to prevent infections are under way, for example, instillation of gentamicin into the bladder regularly at night if the patient uses CIC 16 …”