Hypothesis / aims of study
Intra-Vesical Gentamicin (IVG) installations improve QoL and reduce micro-organism resistance in patients with recurrent UTIs.
Recurrent [r] UTIs can be challenging to manage if there is no structural or functional urological cause identified. In the case of rUTIs, several prophylactic measurements are taken to prevent these infections from occurring ie; lifestyle modifications, prophylaxis antibiotics, and installation of intra-vesical substances. Recurrent UTIs have a detrimental effect on patient QoL, put them at risk of developing potentially life-threatening urosepsis and increases micro-organism resistance to antibiotics which is a global issue.
The aims of the study were to assess if using Intra-Vesical Gentamicin (IVG) could improve QoL by reducing pelvic pain, reduce the recurrence of UTIs and assessing the effects on micro-organism resistance. Another aim was to encourage the patient to self manage their treatment, reduce hospital visits and reduce intervention by primary health care care team.
Study design, materials and methods
Material & Methods:
A treatment protocol was developed and agreed by the local Clinical Effectiveness Committee and 11 patients were identified as suitable for this prospective study. Inclusion criteria were those who failed all conventional treatments for rUTIs which included
>6 proven UTI,s in a twelve month period or
At least one proven uro sepsis requiring hospital admission in the previous twelve months
Discussion with consultant micro biologist to ensure no other oral antibiotics were an option, and that the patients do not have gentamicin resistant organisms.
All conservative treatment exhausted
i.e Fluid Advice, voiding diaries,BAUS Information leaflet on Cystitis, constipation and sexual health
Patients have failed on long term antibiotic prophylaxis including Hipprex
Cystistat or iAluril instillations have failed
Patient able to perform intermittent self catheterisation
Ensure Upper Tract imaging and Cystoscopy have been carried out prior to commencing treatment
All patients were consented to this off-licence use of IVG and given the written protocol. A single nightly instillation of 80 mg Gentamicin diluted in 50 ml of 0/9% normal saline was instigated. The patient was instructed in the technique of intermittent self catheterisation. and how to prepare and administer the IVG. Serum Gentamicin levels were checked seven days post-treatment. If levels were > 1.0 mg/L treatment had to be discontinued (all patient levels were < 1.0 mg/L). Daily instillations were reduced in frequency over subsequent months dictated by response.
We reviewed all positive urine samples pre & post-IVG and documented causative micro-organisms and their sensitivities and resistance.
Interpretation of results