title: Gut-sparing treatment of urinary tract infection in patients at high risk of Clostridium difficile infection.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: BioTechnology Institute, University of Minnesota, 140 Gortner Labs, 1479 Gortner Avenue, St Paul, MN 55108, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Staley
authors.affiliation: Department of Medicine Division of Gastroenterology, University of Minnesota, 401 East River Parkway, Variety Club Research Center, 1st Floor - Suite 131, Minneapolis, MN, 55455, USA.
authors.forename: Byron P
authors.initials: BP
authors.lastname: Vaughn
authors.affiliation: Department of Medicine Division of Gastroenterology, University of Minnesota, 401 East River Parkway, Variety Club Research Center, 1st Floor - Suite 131, Minneapolis, MN, 55455, USA.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Graiziger
authors.affiliation: BioTechnology Institute, University of Minnesota, 140 Gortner Labs, 1479 Gortner Avenue, St Paul, MN 55108, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sadowsky
authors.affiliation: BioTechnology Institute, University of Minnesota, 140 Gortner Labs, 1479 Gortner Avenue, St Paul, MN 55108, USA khoru001@umn.edu.|Wallin Biomedical Sciences Building, Center for Immunology, University of Minnesota, 2101 6th St SE, Minneapolis, MN 55414, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Khoruts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects; D003015:Clostridium Infections / Q000382:microbiology / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000187:drug effects* / Q000235:genetics; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D014552:Urinary Tract Infections / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D012336:RNA, Ribosomal, 16S; D000583:Amikacin