Presentation Authors: Abdel Hamid Hamed, Jenny Jones*, Suzanne Mcphee, Ayr, United Kingdom, Ursula Altmeyer, Kilmarnock, United Kingdom, Robert N Meddings, Brian Little, Holly Bekarma, Ayr, United Kingdom
Introduction: 1-3% of all GP consultation in the UK are related to Urinary Tract Infections (UTI), with the majority managed in primary care. Nevertheless, recurrent[r] UTIs requires urological input. The standard management includes lifestyle and behavior modifications, non-microbial measures and antibacterial prophylactics.This study aimed to assess the benefit of Intra-Vesical Gentamicin (IVG) in reducing rUTI, impact on pain scores and if its usage increases antibiotic resistance in patients who failed conventional treatments.
Methods: A treatment protocol was developed and approved by the local Clinical Effectiveness Committee. Inclusion criteria were patients who failed all conventional treatments with clinical data available twelve months before and a variable period after initiating prophylactic IVG installations. These patients had at least 6 symptomatic UTIs (+ve MSU and requiring treatment with Antibiotics (Abx)) or at least one admission with urosepsis needing Intra-Venous (IV) Abx._x000D_
All patients consented to this off-license use of IVG. A single nightly installation of 80 mg Gentamicin diluted in 50 ml of 0.9% normal saline was instigated. 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.
Results: Eleven patients were included (ten females, one male) with an average age of 45 (70-22), average BMI: 23.6 (29-17) and average treatment period: 7 months (2-18). All patients were independent in administration. Overall 10 out of 11 (91%) had an improvement in their pelvic pain & rate of rUTI. Comparing pre and post IVG results, there was improvement in pain scores 9.8/10 to 5.1/10 and number of symptomatic UTIs reduced from 8.3 to 1.8. There were fewer admissions for intravenous ABx (mean 1.45 to 0.36) and fewer multidrug resistance organisms after IVG (mean 7.38 vs. 1)._x000D_
Interestingly, out of the 97 positive MSUs pre-IVG three MSUs grow Gentamicin resistance microorganisms and the post-IVG MSUs none of the microorganisms showed resistance to Gentamicin.
Conclusions: The initial results have shown that IVG improves QoL, can be used safely and without increasing multidrug-resistant microorganisms in treating intractable UTI that failed conventional treatment. Further follow up is required as a more prolonged period post-treatment is needed to assess effectiveness._x000D_
References:- MeReC (1995) Urinary tract infection. MeReC Bulletin