Intravesical Gentamicin Instillation in Children with Neurogenic Bladder

Without increasing the development of bacterial resistance to gentamicin, intravesical gentamicin instillation reduces the overall risk of urinary tract infections (UTI) and asymptomatic infections in children with neurogenic bladder (NGB), says an article published in the Journal of Pediatric Urology.

Children with neurogenic bladder who have recurrent UTIs have a higher risk of urosepsis and end-stage renal disease-related morbidity and death (ESRD). Intravesical gentamicin instillation has also been used to prevent these recurrences because low-dose prophylactic antibiotics have become less effective since the onset of extended-spectrum beta-lactamase (ESBL) organisms, but there is little information about its use in children in the literature. In order to compare the effectiveness of intravesical gentamicin instillation with oral antibiotic prophylaxis and assess its impact on microorganisms' antibiotic resistance, Manal Mouhssine and colleagues did this study.

This study involved 17 NGB children who were cared for at a tertiary facility and was retrospective in nature. The first term of oral antibiotic prophylaxis was followed by an intravenous injection of gentamicin. For each kid, a matched comparison of the frequency of UTIs, the detected bacteria, and their susceptibility to antibiotics was carried out in a conditional negative binomial regression model.

Key Findings

• Intravesical gentamicin instillation did not significantly vary from antibiotic prophylaxis in terms of the annual rate of UTI, symptomatic UTI, or hospital admissions for intravenous antibiotic treatment.
• Five children (31%) experienced gentamicin-resistant UTIs after intravesical gentamicin instillation, which was comparable to the rate before the treatment (p = 0.76), but it was associated with a 38% decrease in the incidence rate ratio of UTI (p = 0.04) and a 75% reduction in asymptomatic UTI (p = 0.006).

Although there was no significant difference in the rate of symptomatic UTIs or UTIs requiring admissions, this was likely due to the small sample size. However, the overall rate of UTI and asymptomatic infections were significantly lower with intravesical gentamicin instillation than during oral antibiotic therapy. Additionally, with intravenous gentamicin instillation, neither an appearance of ESBL infections nor a rate of pathogen resistance to gentamicin was seen.

Reference

Mouhssine, M., Al Ani, D., Al Shibli, A., Ghatasheh, G., Al Amri, A., Matta, H., Chedid, R., & Narchi, H. (2022). Intravesical gentamicin instillation in the prevention of recurrent urinary tract infections in children with neurogenic bladder- a single-center retrospective observational study. In Journal of Pediatric Urology. Elsevier BV. https://doi.org/10.1016/j.jpurol.2022.09.001