The Effects of Gentamicin Intravesical Bladder Instillations on Decreasing Urinary Tract Infections After Spinal Cord Injury and Disease.

Abstract

Introduction: Recurrent urinary tract infections (UTIs) are common and source of significant morbidity for patients with spinal cord injury/disease (SCI/D) who require clean intermittent catheterization (CIC) bladder management. The purpose of this study was to examine the effectiveness of gentamicin bladder instillations in reducing recurrent UTIs and their impact on neurogenic bladder and bowel (NBB) symptoms and common complications; on quality of life (QOL) and community participation for patients with SCI/D performing CIC.

Materials and methods: This is a Prospective single arm feasibility trial of gentamicin bladder instillations. The 6 month intervention consisted of nightly bladder instillations of 30 mg of gentamicin diluted in 50 mL of normal saline. Participants underwent blood and urine testing and completed patient reported measures, both before and after treatment. The primary outcome was the count of UTIs compared across time points (pre-, during and post-treatment) using an UTI incidence rate ratio and paired t tests. Qualitative data was collected post-treatment.

Results: Twenty-one participants enrolled and 11 completed the trial. The rate of UTIs per person per month decreased significantly over time. Before treatment, the total number of UTIs was 35 (0.53 UTI per person per month); during treatment was 6 (0.09 per person per month) and at follow up, 13 (0.18 per person per month). QOL improved significantly with exception of satisfaction with role activities and community participation. There were no significant changes in NBB symptoms and related complications. Participants reported few adverse events (AEs) and qualitative data indicated high overall treatment satisfaction.

Conclusions: Gentamicin instillations were effective in reducing the rate of UTIs by 83% and improving QOL. Findings helped identify potential challenges and opportunities for future studies.