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• W2898082190 abstract "No AccessJournal of UrologyAdult Urology1 Mar 2019Intravesical Gentamicin Treatment for Recurrent Urinary Tract Infections Caused by Multidrug Resistant Bacteria Janneke E. Stalenhoef, Cees van Nieuwkoop, Petra H. Menken, Sandra T. Bernards, Henk W. Elzevier, and Jaap T. van Dissel Janneke E. StalenhoefJanneke E. Stalenhoef *Correspondence: Department of Infectious Diseases, Leiden University Medical Center, P. O. Box 9600, 2300 RCLeiden, The Netherlands (telephone: +31 71 5262613; FAX: +31 71 5266758; e-mail: E-mail Address: [email protected]). Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Cees van NieuwkoopCees van Nieuwkoop Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands More articles by this author , Petra H. MenkenPetra H. Menken Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Sandra T. BernardsSandra T. Bernards Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , Henk W. ElzevierHenk W. Elzevier Department of Urology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author , and Jaap T. van DisselJaap T. van Dissel Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.10.004AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract 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. References 1. : Impact of allergy and resistance on antibiotic selection for recurrent urinary tract infections in older women. Urology 2018; 113: 26. Google Scholar 2. : Guidelines on urological infections. European Association of Urology 2013. Available at http://www.uroweb.org/gls/pdf/18_Urological%20infections_LR.pdf2013. Accessed October 3, 2018. 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Google Scholar 9. : Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization. Can Urol Assoc J 2017; 11: E350. Google Scholar 10. : Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis, suppl., 1992; 15: S216. Google Scholar 11. : Treatment duration of febrile urinary tract infection: a pragmatic randomized, double-blind, placebo-controlled non-inferiority trial in men and women. BMC Med 2017; 15: 70. Google Scholar 12. The European Committee on Antimicrobial Susceptibility Testing—EUCAST: Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 8.0, 2018. Available at http://www.eucast.org. Accessed October 3, 2018. Google Scholar 13. European Centre for Disease Prevention and Control: Antimicrobial Resistance Surveillance in Europe 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net), 2017. Available at https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/antimicrobial-resistance-europe-2015.pdf. Accessed October 3, 2018. Google Scholar 14. : EUCAST expert rules in antimicrobial susceptibility testing. Clin Microbiol Infect 2013; 19: 141. Google Scholar 15. : Treatment of intractable bacterial cystitis with intermittent catheterization and antimicrobial instillation: case report. J Urol 1987; 137: 495. Link, Google Scholar 16. : Intravesical instillation of gentamicin sulfate: in vitro, rat, canine, and human studies. Urology 1994; 43: 531. Google Scholar 17. : Safety of gentamicin bladder irrigations in complex urological cases. J Urol 2006; 175: 1861. Link, Google Scholar 18. : Neomycin toxicity in bladder irrigation. J Urol 1993; 150: 1199. Link, Google Scholar 19. : Neomycin-induced perception deafness following bladder irrigation in patients with end-stage renal disease. Br J Urol 1995; 76: 479. Google Scholar 20. : The use of intravesical gentamicin to treat recurrent urinary tract infections in lower urinary tract dysfunction. Neurourol Urodyn 2017; 36: 2109. Google Scholar 21. : Extended-spectrum beta-lactamase-producing enterobacteriaceae among travelers from the Netherlands. Emerg Infect Dis 2013; 19: 1206. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by an unrestricted grant from ZonMw (Project No. 836011028) and the Franje1 Foundation. The funding organizations had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation or approval of the manuscript; or decision to submit the manuscript for publication. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 3, (411-413), Online publication date: 1-Mar-2019. Volume 201Issue 3March 2019Page: 549-555Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsurinary bladderurinary tract infectionsdrug resistancemicrobialgentamicinsantibiotic prophylaxisAcknowledgementsDrs. F. M. J. A. Froeling, L. C. Gerbrandy-Schreuders and M. T. M. Kummeling referred patients. M. J. Vermaire and C. M. M. de Jong-Mom assisted with patient instructions and study administration.MetricsAuthor Information Janneke E. Stalenhoef Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands *Correspondence: Department of Infectious Diseases, Leiden University Medical Center, P. O. Box 9600, 2300 RCLeiden, The Netherlands (telephone: +31 71 5262613; FAX: +31 71 5266758; e-mail: E-mail Address: [email protected]). More articles by this author Cees van Nieuwkoop Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands More articles by this author Petra H. Menken Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Sandra T. Bernards Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Henk W. Elzevier Department of Urology, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Jaap T. van Dissel Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by an unrestricted grant from ZonMw (Project No. 836011028) and the Franje1 Foundation. The funding organizations had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation or approval of the manuscript; or decision to submit the manuscript for publication. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ..." @default.
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