PD10-09 GENTAMICIN INTRAVESICAL INSTILLATIONS DECREASE SYMPTOMATIC URINARY TRACT INFECTIONS AND ORAL ANTIBIOTIC USE IN PATIENTS WITH NEUROGENIC BLADDER ON INTERMITTENT CATHETERIZATION

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction II1 Apr 2015PD10-09 GENTAMICIN INTRAVESICAL INSTILLATIONS DECREASE SYMPTOMATIC URINARY TRACT INFECTIONS AND ORAL ANTIBIOTIC USE IN PATIENTS WITH NEUROGENIC BLADDER ON INTERMITTENT CATHETERIZATION Lindsey Cox, J. Quentin Clemens, and Anne Cameron Lindsey CoxLindsey Cox More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , and Anne CameronAnne Cameron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent urinary tract infections (UTIs) are a morbid and costly clinical problem in patients with neurogenic bladder (NGB). Strategies for preventing UTIs are lacking in evidence. The use of prophylactic bladder instillations is described in the literature, but only in small cohorts. Daily intravesical gentamicin instillations for the prevention of UTIs is a commonly used clinical strategy for NGB patients on intermittent catheterization (IC) in our institution. We sought to determine if gentamicin bladder instillations reduce the rate of symptomatic UTIs, the use of oral/intravenous antibiotics, and/or the frequency of telephone encounters with their treating urologist for this population. METHODS We queried an IRB approved institutional Neurogenic Bladder database to identify subjects. Inclusion criteria included NGB of any etiology on IC for the period 6 months before and 6 months after initiating prophylactic intravesical gentamicin instillations. Exclusion criteria included short-term instillations only, less than 6 months follow up, discontinuation of IC (>4 weeks of indwelling catheter or urinary diversion). Symptomatic UTIs were defined as a patient complaint of symptoms consistent with past UTIs and treatment with antibiotics. Significance testing was performed using McNemar's, Wilcoxon signed-rank tests to evaluate paired variables before and after gentamicin instillations RESULTS Of 50 subjects identified, 22 met inclusion criteria after chart review. Subjects had a median age of 37.5 years, 63.6% had a spinal cord injury, 13.6% have multiple sclerosis, with median time since injury/diagnosis of 14 years. Patients used less oral antibiotic prophylaxis after gentamicin instillations were initiated (p=0.0016) and had fewer symptomatic UTI's (3.6 vs 0.73 episodes, p<0.0001); courses of treatment oral antibiotics (3.8 vs 0.91, p<0.0001); and telephone encounters for UTI's (2.3 vs 0.45, p=0.0011). CONCLUSIONS Gentamicin bladder instillations significantly decrease symptomatic UTI episodes and oral antibiotic use in patients with NGB. Prospective, placebo-controlled, longer-term trials are needed to determine if this effect is generalizable. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e203-e204 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lindsey Cox More articles by this author J. Quentin Clemens More articles by this author Anne Cameron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...