Gut-sparing treatment of urinary tract infection in patients at high risk of Clostridium difficile infection

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Background: Recipients of faecal microbiota transplantation (FMT) in treatment of recurrent Clostridium difficile infection (RCDI) remain at markedly increased risk of re-infection with C. difficile with new antibiotic provocations. Urinary tract infections (UTIs) are common indications for antibiotics in these patients, often resulting in C. difficile re-infection. Methods: We present a case series of 19 patients treated with parenteral aminoglycosides for UTI following FMT for RCDI. A 3 day outpatient regimen of once-daily intramuscular administration of gentamicin was used to treat 18 consecutive FMT recipients with uncomplicated UTI. One other patient was treated for a complicated UTI with intravenous amikacin. Profiling of 16S rRNA genes was used to track changes in faecal microbial community structure during this regimen in three patients. Results: The protocol was highly effective in treating UTI symptoms. None of the patients suffered a re-infection with C. difficile. The faecal microbial communities remained undisturbed by treatment with intramuscular administration of gentamicin. Conclusions: Despite falling out of favour in recent years, aminoglycoside antibiotics given parenterally have the advantage of minimal penetration into the gut lumen. A brief (3 day) course of parenteral gentamicin was safe and effective in curing UTI in patients at high risk of C. difficile infection without perturbing their gut microbiota.

Original languageEnglish (US)
Pages (from-to)522-528
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Issue number2
StatePublished - Feb 2017

Bibliographical note

Funding Information:
This research was made possible by support of grants from the National Institutes of Health (NIH) 1R21-AI114722-01 (A. K., M. J. S.) and the Minnesota's Discovery, Research, and InnoVation Economy grant from the University ofMinnesota (A. K., M. J. S.).

Publisher Copyright:
© The Author 2016.


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