Prophylaxis with intravesical overnight instillation of gentamicin reduces the number of recurrences of UTI in patients with recurrent urinary tract infections due to multi-drug resistant bacteria, as compared to oral antibiotic prophylaxis.
ID
Bron
Verkorte titel
Aandoening
recurrent urinary tract infections
multi-drug resistant bacteria
cystitis
prophylaxis
recidiverende urineweginfecties
multi resistente bacterieen
Ondersteuning
Onderzoeksproduct en/of interventie
Uitkomstmaten
Primaire uitkomstmaten
The number of UTI per patient after start of intravesical gentamicin or oral antibiotic prophylaxis during 6 months (period of prophylactic treatment) and 12 months (total follow up)
Achtergrond van het onderzoek
Rationale: Management of patients with recurrent urinary tract infections (UTI) is challenging, even more so in the era of rising antimicrobial resistance. Multidrug-resistance is currently leading to an increased need for intravenous treatment of UTIs with reserve antibiotics and subsequent hospitalizations. Prophylaxis with low dose oral antibiotics, as recommended by current guidelines, is often limited by multidrug-resistance of uropathogens, and if possible may even further extent the development of resistance. In such patients with recurrent UTI due to multi-drug resistant uropathogens, intravesical gentamicin installation is a potential valuable treatment option for either suppression or prevention of UTI. Locally administered aminoglycosides bypass systemic toxicity and development of antimicrobial resistance is unlikely because of high urinary levels and lack of antibiotic pressure on commensal gut flora.
Doel van het onderzoek
Prophylaxis with intravesical overnight instillation of gentamicin reduces the number of recurrences of UTI in patients with recurrent urinary tract infections due to multi-drug resistant bacteria, as compared to oral antibiotic prophylaxis.
Onderzoeksopzet
Follow up at wk 1, 2, 7-8, 12-14, 22-24, 34-36, 2 months, 3 months, 6 months, 9 months and 12 months.
Onderzoeksproduct en/of interventie
Randomization 2:2:1:
1. Intravesical installations of gentamicin during a period of 24 weeks (once daily for 2 weeks, every other day for 10 weeks, twice weekly for 12 weeks).
2. Low dose oral antibiotic prophylaxis based on prior susceptibility pattern of isolated uropathogens and patient characteristics, reflecting current standard care, for 24 weeks.
3. Wait and see policy without antimicrobial prophylaxis. In case of a first UTI after enrolment, patients will be randomized to study group 1 or 2.
Publiek
Dept. of Infectious Diseases, C5P
PO Box 9600
J.E. Stalenhoef
Leiden 2300 RC
The Netherlands
J.E. Stalenhoef@lumc.nl
Wetenschappelijk
Dept. of Infectious Diseases, C5P
PO Box 9600
J.E. Stalenhoef
Leiden 2300 RC
The Netherlands
J.E. Stalenhoef@lumc.nl
Belangrijkste voorwaarden om deel te mogen nemen (Inclusiecriteria)
- Competent patient aged 18 or above.
- A history of recurrent cystitis, defined as:
a. females: at least 2 episodes of UTI in the last 6 months or 3 in the last 12 months
b. males: at least 2 episodes of UTI in the last 12 months (including recurrent cystitis likely due to chronic bacterial prostatitis).
- At least one episode of these infections is documented by urine culture with the isolation of >10^3 CFU/mL of an identified MDR pathogen. Multidrug resistance is defined as acquired non-susceptibility to at least one agent in three or more antimicrobial classes.
- All other episodes at least by one urinary symptom* and positive urinary nitrate test or leukocyturia (as depicted by positive leukocyte esterase test or microscopy).
- No clinical symptoms of UTI at enrolment.
Ad * Definitions of urinary symptoms:
- Dysuria: pain, tingling or burning sensation in the perineum during or just after urination.
- Frequency: more than usual, abnormal, frequent voiding.
- Urgency: unusual intense and sudden desire or urge to void.
- Suprapubic and/or perineal pain.
Belangrijkste redenen om niet deel te kunnen nemen (Exclusiecriteria)
- Urinary culture in prior 6 months tested positive for high-level gentamicin resistant enterobacteriaceae or enterococci (MIC >128 mg/L).
- Abnormalities of the upper urinary tract, including presence of urinary stones.
- Patients with a permanent urinary catheter.
- Complete urinary incontinence.
- Patients with stage 5 chronic kidney disease (GFR <15 ml/min).
- Patients with known hypersensitivity to gentamicin.
- Pregnancy or lactation.
- Inability to provide informed consent.
Opzet
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In overige registers
| Register | ID |
|---|---|
| NTR-new | NL4404 |
| NTR-old | NTR4646 |
| CCMO | NL46991.058.13 |
| OMON | NL-OMON38402 |