Intravesical gentamicin instillation in the prevention of recurrent urinary tract infections in children with neurogenic bladder- a single-center retrospective observational study

Mouhssine, Manal; Ani, Dania Al; Shibli, Amar Al; Ghatasheh, Ghassan; Amri, Abdulla Al; Matta, Hilal; Chedid, Roy; Narchi, Hassib

doi:10.1016/j.jpurol.2022.09.001

Cited by 5 publications

(9 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The target plasma concentration needed to prevent AMR was estimated to be 4-1000-fold higher than the MIC [122], which is, however, unfeasible via the oral route because of the toxicity and the narrow therapeutic indices, which refer to the narrow margin between a toxic dose and dose needed for plasma MIC of OAT. The recommendation of the pharmacokinetic/pharmacodynamic modelling of OAT is consistent with the deployment of an overwhelming force upon the first contact with the adversary (microbes) for extinguishing any hope of resurgence by adversary (i.e., after gaining AMR) [123]. Accordingly, the urine concentration of OAT upon the first contact with the microbial colonies [6,7] infecting the urothelium is a crucial determinant of the emergence of a drug-resistant strain that proliferates exponentially to survive even subsequently higher drug concentration in urine (Figure 2).…”

Section: Root Cause Analysis Of Amr-delay and Variability In Urinary Micmentioning

confidence: 66%

“…As opposed to the urine and plasma plots of OAT shown in Figure 2B, the plot in Figure 5B is projected from a recent study on post-operative prophylaxis by intravesical gentamicin [160]. As depicted by the low plasma levels (red curve in Figure 5B), the limited The principle of the five "Ds" can be best illustrated by an intravesical gentamicin dose of 80 mg [155][156][157][158][159] (Figure 5B), delivering a bactericidal concentration with a 90% elimination of live bacteria within 3 h of administration, with a comparative lower incidence of AMR [140] and recurrence [37] than those reported with OAT [38,123]. As opposed to the urine and plasma plots of OAT shown in Figure 2B, the plot in Figure 5B is projected from a recent study on post-operative prophylaxis by intravesical gentamicin [160].…”

Section: Discussionmentioning

confidence: 98%

“…While absorbed OAT can reach pathogens in upper urinary tracts via perfused blood, the uropathogens causing cystitis can only be eliminated by the urinary fraction of absorbed OAT (Figure 2), because the circulating levels [126,127,130] of the drug are less likely to reach the planktonic microbes and those attaching to the apical side of umbrella cells (Figure 1); (3) The battle between OAT and the uropathogens provoking cystitis is heavily influenced by the physiology of urine flow [20,25,113] and drug physiochemistry [107,132]; (4) The principle of the five Ds-drug, dose, duration, drug route, and de-escalation-for AMS [44] advocates for obtaining the right drug concentration in urine above the MIC (Figures 2-5) [124,154]. The principle of the five "Ds" can be best illustrated by an intravesical gentamicin dose of 80 mg [155][156][157][158][159] (Figure 5B), delivering a bactericidal concentration with a 90% elimination of live bacteria within 3 h of administration, with a comparative lower incidence of AMR [140] and recurrence [37] than those reported with OAT [38,123]. As opposed to the urine and plasma plots of OAT shown in Figure 2B, the plot in Figure 5B is projected from a recent study on post-operative prophylaxis by intravesical gentamicin [160].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

Tyagi,

Stewart

et al. 2024

Antibiotics

View full text Add to dashboard Cite

Nearly 150 million cases of urinary tract infections (UTIs) are reported each year, of which uncomplicated cystitis triggers > 25% of outpatient prescriptions of oral antimicrobial treatment (OAT). OAT aids immune cells infiltrating the urothelium in eliminating uropathogens capable of invading the urothelium and surviving hyperosmotic urine. This self-evident adaptability of uropathogens and the short interval between the introduction of Penicillin and the first report of antimicrobial resistance (AMR) implicate AMR as an evolutionary conserved heritable trait of mutant strains selected by the Darwinian principle to survive environmental threats through exponential proliferation. Therefore, AMR can only be countered by antimicrobial stewardship (AMS) following the principle of the five Ds—drug, dose, duration, drug route, and de-escalation. While convenient to administer, the onset of the minimum inhibitory concentration (MIC) for OAT in urine leaves a window of opportunity for uropathogens to survive the first contact with an antimicrobial and arm their descendant colonies with AMR for surviving subsequent higher urine antimicrobial levels. Meanwhile, the initial dose of intravesical antimicrobial treatment (IAT) may be well above the MIC. Therefore, the widespread clinical use of OAT for cystitis warrants an analysis of the strengths, weaknesses, opportunity, and threats (SWOTs) and a root cause analysis of the AMR associated with OAT and IAT.

show abstract

Section: Root Cause Analysis Of Amr-delay and Variability In Urinary Micmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

Tyagi,

Stewart

et al. 2024

Antibiotics

View full text Add to dashboard Cite

show abstract

“…However, Kaplan‐Meier curves showed a significant improvement ( p = 0.018) when the patients received intravesical gentamicin compared to when they had previously received oral prophylactic antibiotics 20 . Another study in seventeen children with NB found that intravesical gentamicin, when compared to oral antibiotics, lowered the overall rate of UTIs by 50% ( p = 0.04) and the rate of asymptomatic UTIs by 63% ( p = 0.006), but did not affect the rate of symptomatic UTIs ( p = 0.2) 21 …”

Section: The Current Role Of Antibioticsmentioning

confidence: 98%

“…20 Another study in seventeen children with NB found that intravesical gentamicin, when compared to oral antibiotics, lowered the overall rate of UTIs by 50% (p = 0.04) and the rate of asymptomatic UTIs by 63% (p = 0.006), but did not affect the rate of symptomatic UTIs (p = 0.2). 21 The benefit of intravesical administration is the low risk of systemic absorption and subsequent side effects. However, this mode of prophylaxis is not routinely used in NB patients, and there are no consensus guidelines to standardize their use.…”

Section: The Current Role Of Antibioticsmentioning

confidence: 99%

The rationale for bladder washouts in children with neurogenic bladder

Singh,

Deshpande,

Schlegel

et al. 2024

Neurourology and Urodynamics

View full text Add to dashboard Cite

Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long‐term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are at risk of colonization and development of antibiotic resistance. Bladder washouts with non‐antibiotic electrochemically activated solutions are a potential new prophylactic option for patients with bladder dysfunction when clean intermittent catheterization has resulted in chronic bacteriuria.

show abstract

Is Intravesical Gentamicin the New Gold Standard to Manage Refractory Urinary Tract Infections?—Experience From a Dedicated Multidisciplinary Complex UTI Clinic

Chitteti,

Ekpeno,

Morris‐Laverick

et al. 2024

Neurourology and Urodynamics

View full text Add to dashboard Cite

AimsTo assess the effectiveness of intravesical gentamicin in managing recurrent urinary tract infections (rUTIs) refractory to first‐ and second‐line treatments.Methods and MaterialsThis 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.ResultsA 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).ConclusionIn 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.

show abstract

Intravesical gentamicin instillation in the prevention of recurrent urinary tract infections in children with neurogenic bladder- a single-center retrospective observational study

Cited by 5 publications

References 15 publications

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

The rationale for bladder washouts in children with neurogenic bladder

Is Intravesical Gentamicin the New Gold Standard to Manage Refractory Urinary Tract Infections?—Experience From a Dedicated Multidisciplinary Complex UTI Clinic

Contact Info

Product

Resources

About