Janneke E Stalenhoef1, Cees van Nieuwkoop2, Petra H Menken1, Sandra T Bernards3, Henk W Elzevier4, Jaap T van Dissel1. 1. Departments of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. 2. Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands. 3. Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
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.
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.
Authors: Kristian Stærk; Rasmus Birkholm Grønnemose; Yaseelan Palarasah; Hans Jørn Kolmos; Lars Lund; Martin Alm; Peter Thomsen; Thomas Emil Andersen Journal: Front Microbiol Date: 2021-06-25 Impact factor: 5.640
Authors: Sander G Kuiper; Anneke C Dijkmans; Erik B Wilms; Ingrid M C Kamerling; Jacobus Burggraaf; Jasper Stevens; Cees van Nieuwkoop Journal: J Antimicrob Chemother Date: 2020-11-01 Impact factor: 5.758