Is Intravesical Gentamicin the New Gold Standard to Manage Refractory Urinary Tract Infections?-Experience From a Dedicated Multidisciplinary Complex UTI Clinic.

Aims: To assess the effectiveness of intravesical gentamicin in managing recurrent urinary tract infections (rUTIs) refractory to first- and second-line treatments.

Methods and materials: This single-centre prospective cohort study included 41 patients treated with intravesical gentamicin over a 24-month period from 2021 to 2023. A multidisciplinary team comprising functional urologists, microbiologists, and specialist nurses was involved in the decision-making process and in designing the treatment protocol. Patients self-administered gentamicin instillations into the bladder according to a 6-month instillation schedule. Patients were followed up during and after the treatment period to assess the treatment response.

Results: A total of 41 patients with rUTIs were treated using the 6-month intravesical gentamicin regimen. Of these, 10 were male and 31 were female, with a mean age of 53 years. E. coli was isolated from urine cultures in 19 patients (46%), while 19 patients had multiple organisms. Serum gentamicin levels were undetectable in all patients 1 week after treatment initiation. The mean follow-up period was 15 months with minimum follow up of 6 months for all patients. Following gentamicin administration, hospital admission rates due to urosepsis decreased from 46% to 5%, and the prevalence of multidrug-resistant organisms in urine cultures decreased from 44% to 10%. A significant reduction in UTI frequency was observed in 80.5% of patients, with 71% reporting good to excellent Patient Global Impression of Improvement (PGI-I) scores. Additionally, 76% of patients reported a significant improvement in Quality of Life (QoL).

Conclusion: In our cohort of patients with recurrent and refractory UTIs, intravesical gentamicin instillations has shown to be both safe and effective, leading to notable improvements in patients' symptoms and QoL.