Use of Prophylactic Gentamicin Instillations in Patients with Neurogenic Lower Urinary Tract Dysfunction at a Pediatric Institution
Diana K. Bowen, MD1, Theresa Meyer, MS2, Elizabeth Adams, BA1, Ilina Rosoklija, MPH2, Elizabeth Yerkes, MD2, David Chu, MD MSCE2.
1Northwestern University, Chicago, IL, USA, 2Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. ABSTRACT
Introduction: A small number of pediatric studies have demonstrated intravesical gentamicin instillation to be a safe prophylactic measure to prevent urinary tract infections (UTIs) in patients with neurogenic lower urinary tract dysfunction (NLUTD) who catheterize. We describe a robust cohort of pediatric patients with NLUTD utilizing intravesical gentamicin. The objectives of the study were to 1) Evaluate whether there was a reduction in UTI frequency after initiating gentamicin prophylaxis; 2) Determine if UTI-related hospitalizations decreased with gentamicin use; 3) Assess for increased gentamicin resistance with use of bladder instillations.
Methods: A retrospective cohort study of patients with NLUTD at a pediatric institution who have used prophylactic gentamicin instillations between 2007 and 2022 was conducted. Exclusion criteria included absence of at least one symptomatic UTI documented in the medical record one year prior to gentamicin initiation. The number of UTIs and UTI-related hospitalizations for each patient were abstracted. UTI was defined as presence of urologic symptoms associated with documented positive culture that was treated by the physician. Urine culture data was reviewed for gentamicin resistance; cultures were excluded from the resistance analysis if no susceptibility testing for gentamicin was done. Statistical significance was assessed using Wilcoxon signed-rank test and chi-square as appropriate.Results: Thirty patients with NLUTD were included in the study. Median length of time using gentamicin instillations was 2.4 years (IQR 1,4). Overall, there was a significant reduction in the median number of UTIs per year after initiation of gentamicin from 2.0
[IQR 1,4] before gentamicin to 0.7 [IQR 0, 1.9] while using gentamicin (p= 0.0004). The median rate of UTI-related inpatient admissions while on gentamicin decreased as well (1 admission/year [IQR 0,2] vs. 0 admissions/year [IQR 0, 0.4]. The proportion of cultured bacteria resistant to gentamicin did significantly increase after initiation of the instillations from 8% to 39% (p<0.0001). Conclusions: Gentamicin instillations significantly reduced the number of UTIs and UTI-related hospitalizations in a pediatric cohort of patients with NLUTD who catheterize. Our cohort did show increased bacterial resistance to gentamicin while on prophylactic instillations. Prospective studies in patients with NLUTD are needed to further define the ideal administrative protocol and patient characteristics for optimal therapeutic success, as well as understand the effects and implications on the microbiome.
Back to 2023 Abstracts