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Antibiotic Prophylaxis After Urinary Catheter Removal Lowers Risk for Symptomatic Urinary Tract Infection

Summary and Comment |
July 11, 2013

Antibiotic Prophylaxis After Urinary Catheter Removal Lowers Risk for Symptomatic Urinary Tract Infection

  1. Paul S. Mueller, MD, MPH, FACPAU1471

But widely applied, this practice undoubtedly would lead to antibiotic-associated adverse events and antibiotic resistance.

  1. Paul S. Mueller, MD, MPH, FACPAU1471

Urinary catheterization, which is common in hospitalized patients, is associated with symptomatic urinary tract infections (UTIs). In a meta-analysis of seven trials (6 randomized and 1 nonrandomized) that involved 1520 patients (mostly postsurgical) who underwent short-term catheterization (≤14 days), investigators determined whether administering antibiotic prophylaxis at the time of urinary catheter removal lowers risk for symptomatic UTI.

In all trials, researchers compared antibiotic prophylaxis versus placebo or usual care. Antibiotics used were ciprofloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, and cefotaxime. Duration of antibiotic prophylaxis ranged from single doses to 3 days. Symptomatic UTIs occurred in 10.5% of control patients and in 4.7% of prophylaxis patients. Hence, antibiotic prophylaxis resulted in a 5.8% absolute risk reduction for symptomatic UTI (number needed to treat to prevent 1 symptomatic UTI, 17).

Comment

Although these results suggest that antibiotic prophylaxis at the time of urinary catheter removal prevents symptomatic UTIs, clinicians should be wary of applying these results broadly. If every hospitalized patient with a urinary catheter received prophylaxis, antibiotic use would increase markedly, which undoubtedly also would increase adverse events (e.g., antibiotic-associated side effects, Clostridium difficile infections), antibiotic resistance, and costs.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Secretary)

Citation(s):

Reader Comments (5)

Dorota Aleksandra Krakowska, MD Other, Family Medicine/General Practice, Poland

The need for surgical clear urinal tract area is good step on kidney failure elimination, but it is strong advice to use other pharmacy such as furaginum and vitaminum C in antibiotic resistence possibility and way of valueable microbiology estimation of bacteria in properly antibiotic treatment worsen cases.

Madhumanee Abeywardena Fellow-In-Training, Other, Microbiology Department, Leicester Royal Infirmary Hospital

Has the single dose being as effective as three days prophylactic doses? If so, there cannot be many antibiotic associtaed side effects, in which case benefit must be greater.

Gordon Huth, MD

I am astounded by the 10.5% occurrence of "symptomatic UTI's" in the controls and 4.7% in the prophylaxed patients. If this were true, wouldn't we have heard about all these symptomatic UTI's from the patients when they receive their FU care? I think that the vast majority of these "UTI's" must go undetected and untreated without significant consequences...

Hagai Almagor PhD, DVM Other, Haiviva Veterinary Clinic, Jerusalem, Israel

From my experience in our patients (dogs and cats and some exotic species) in most of the UTI's E.coli is isolated (over 90%), and sometimes Streptococcus, Proteus, Pseudomonas and other bacteria. E.coli is very variable in its antibiogram. My question is: wouldn't it be more appropriate to culture every post-catheter-removal patient (say, three days after catheter removal) and treat only positive-culture patients with the most appropraite antibiotic according to the bacterial biogram?
Wouldn't it be also less expensive?

Dr.N.V.Krishnarao M.D. Physician, Internal Medicine, Vijay awards, A.P.state ,India

Prophylactic antibiotic prescription is a necessity

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