Summary
Background
Recurrent urinary tract infections (UTI) in children with neurogenic bladder (NGB)
put them at high risk of morbidity and mortality from urosepsis and end-stage renal
disease (ESRD). Since the efficacy of low-dose prophylactic antibiotics to prevent
these recurrences has been declining since the emergence of extended-spectrum beta-lactamase
(ESBL) organisms, intravesical gentamicin instillation has also been used, but only
scarce data in children is available in the literature.
Objective
We evaluate the efficacy of intravesical gentamicin instillation to reduce UTIs in
children with NGB, compare it with oral antibiotic prophylaxis and determine its effect
on pathogens resistance to antibiotics.
Study design
Retrospective observational study of 17 children with NGB managed in a tertiary center.
Intravesical gentamicin instillation followed an initial period of oral antibiotic
prophylaxis. In a conditional negative binomial regression model, a matched comparison
of the rate of UTIs, the identified pathogens and their antibiotics susceptibility
between the two therapies was performed for each individual child,
Results
When compared to antibiotic prophylaxis, intravesical gentamicin instillation showed
no significant difference in the yearly rate of UTI, symptomatic UTI, or admissions
for intravenous antibiotic therapy. However, it was associated with a 38% reduction
in the incidence rate ratio of UTI (p = 0.04) and 75% of asymptomatic UTI (p = 0.006) After intravesical gentamicin instillation, five children (31%) had a gentamicin-resistant
UTI, similar to before that treatment (p = 0.76).
Discussion
Although the overall rate of UTI and of asymptomatic infections were significantly
lower with intravesical gentamicin instillation than during oral antibiotic therapy,
there was no significant difference in the rate of symptomatic UTIs or UTIs requiring
admissions, probably because of the small sample size. In addition, neither an emergence
of ESBL pathogens nor the rate of pathogens resistance to gentamicin was observed
with intravesical gentamicin instillation. As to the potential nephrotoxicity of aminoglycosides,
the calculated GFR for all children remained normal. Strengths of our study include
the use of a matched paired comparison of each participant with him/herself with each
treatment modality, thus eliminating potential confounding by some individual characteristics.
In addition, and unlike previous studies, we have also used a robust multivariate
statistical analysis to compare counts and rates of outcomes. Limitations include
the absence of gentamicin serum levels monitoring, of hearing testing, and also the
small sample size.
Conclusion
Intravesical gentamicin instillation decreases the overall rate of UTI and asymptomatic
infections in children with NGB without increasing the rate of bacterial resistance
to gentamicin.
Keywords
Abbreviations:
UTI (Urinary Tract Infection), NGB (Neurogenic bladder), CIC (Clean Intermittent Catheterization), ESRD (End Stage Renal Disease), ESBL (Extended-Release Beta-Lactamase), PO (Per Os), IV (Intravenous)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 22, 2022
Accepted:
September 3,
2022
Received in revised form:
August 26,
2022
Received:
July 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
