Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

Huen, Kathy H.; Nik‐Ahd, Farnoosh; Chen, L.; Lerman, Stephen; Singer, Jennifer S.

doi:10.1016/j.jpurol.2018.12.001

Cited by 26 publications

(18 citation statements)

References 10 publications

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“…Neomycin–polymyxin instillation has recently been shown to be effective in decreasing UTIs in a pediatric population of neurogenic bladder patients on clean intermittent catheterization. In this retrospective cohort study of 52 patients, daily UTI prophylaxis with intravesical antibiotic instillation reduced both UTI rate (incidence rate ratio [IRR], 0.42; p < .001) and hospitalization rate for UTI (IRR, 0.61; p = .043) 12 . There have been a few additional smaller studies evaluating a neomycin or polymyxin solution for UTI management.…”

Section: Discussionmentioning

confidence: 96%

“…In this study of 112 patients, the use of polybactrin genitourinary irrigation resulted in an 11.3% reduction in postprocedure UTIs (5.3% vs. 16.6%) 11 . While the successful utilization of various intravesical antibiotics have been described for UTI management in the ambulatory setting, there have been no contemporary studies evaluating efficacy of bladder antibiotic irrigation in the operating room for the prevention of postoperative UTI 10,12 …”

Section: Introductionmentioning

confidence: 86%

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Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double‐blind randomized controlled trial

Slopnick

Henderson

Chapman

et al. 2020

Neurourology and Urodynamics

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After pelvic reconstructive surgery, the risk of postoperative urinary tract infection (UTI) is significant; intraoperative cystoscopy may contribute to this risk. Intravesical antibiotics are used in the ambulatory setting and may be applied to the surgical arena. Our objective was to evaluate the efficacy of antibiotic irrigation during intraoperative cystoscopy to prevent postoperative UTI. Methods: This double-blind randomized controlled trial enrolled 216 women undergoing cystoscopy with elective surgery for pelvic organ prolapse, stress urinary incontinence, or laparoscopic gynecologic surgery at an academic medical center 2016-2019. Participants were randomized to cystoscopic irrigation fluid type: normal saline (control) or 200,000 U polymyxin B + 40 mg neomycin solution in normal saline (antibiotic). Patients and providers who treated UTIs were blinded. The primary outcome was treatment of UTI within 6 weeks postoperatively, defined as positive culture or treatment for a symptomatic UTI. χ 2 and multivariable logistic regression analyses were performed. Results: We enrolled 216 women: 111 control (51.4%) and 105 antibiotic (48.6%). Mean age was 51.6 years. Groups were well matched in medical comorbidities and surgery type. Primary vaginal surgery was most common (n = 127, 58.8%). Overall, 10.7% of patients developed a postoperative UTI with no difference in incidence between groups: 9.9% of control (n = 11, 95% confidence interval [CI]: 4.0%-16.0%) versus 11.4% of antibiotic subjects (n = 12, 95% CI: 5.0%-18.0%), on χ 2 (p = .718) and logistic regression analysis (adjusted odds ratio, 1.3; CI: 0.53-3.16; p = .569). Conclusion: When cystoscopy is performed during elective pelvic surgery, use of antibiotic irrigation does not impact the rate of postoperative UTI.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 86%

Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double‐blind randomized controlled trial

Slopnick

Henderson

Chapman

et al. 2020

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…Also reported is a significant decrease in frequency of symptomatic urinary infections, along with respective emergency department visits and hospital admissions, for those with neurogenic bladder maintained on clean intermittent catheterization, with the use of intravesical antibiotic instillation. [44]…”

Section: Intravesical Antibioticsmentioning

confidence: 99%

Management of urinary tract infection in women: A practical approach for everyday practice

et al. 2019

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A common health-care problem worldwide, urinary tract infection (UTI), represents a disease of significant impact on every country's economy, being the most common cause of hospitalization among elderly people and the most common cause of antibiotic prescription in primary care. Diagnosing and managing upper and lower UTI have always been a challenge to physicians, given its high prevalence, risk of recurrence and improper treatment, and the fact of worldwide increase in antibiotic resistance, necessitating implementation of a proper antibiotic stewardship. Urinary infections are twice more likely to occur in females compared to males and its prevalence increases with increasing age. The following is a comprehensive review paper about UTI in females, discussing the various factors leading to a complicated infection. The various etiologies and microbiologies of UTI are also highlighted. In addition to various usual antibiotic regimens for treating UTI, a significant number of nonantimicrobial treatment modalities are highlighted and described in this manuscript, including the novel use of intravesical antibiotics and vaccines for suppression treatment. Finally, a pathway is suggested for the proper diagnosis and treatment that ensures antibiotic stewardship in order to decrease long-term complications.

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“…90.4% and 9.6% of patients received neomycin‐polymyxin and gentamicin instillations, respectively. After initiation of intravesical antibiotics, the rate of symptomatic UTIs was reduced by 58% (IRR: 0.42, 95% CI: 0.31–0.56; p < .001), the rate of ED visits was reduced by 54%, and the rate of inpatient hospitalizations for UTI was reduced by 39% 17 . Cox et al tested if the use of gentamicin bladder instillations reduces the rate of symptomatic UTI in NLUTD patients on intermittent self‐catheterization who have recurrent UTIs.…”

Section: Discussionmentioning

confidence: 99%

Bladder irrigation with povidone‐iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

Moussa

Chakra

Papatsoris

et al. 2021

Neurourology and Urodynamics

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Aims: To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs. Methods: We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients. Results: After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001-0.059; p < .001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001-0.059; p < .001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002-0.0035; p < .001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation. Conclusions: Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC.

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Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

Cited by 26 publications

References 10 publications

Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double‐blind randomized controlled trial

Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double‐blind randomized controlled trial

Management of urinary tract infection in women: A practical approach for everyday practice

Bladder irrigation with povidone‐iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

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