title: Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection.
abstract: OBJECTIVE
  We determined whether routine replacement of a chronic indwelling catheter before instituting antimicrobial therapy leads to an improved bacteriological or clinical outcome when treating symptomatic urinary tract infection in elderly nursing home residents.
  
  
  METHODS
  We performed a prospective randomized open clinical trial at 2 long-term care facilities. Patients were randomized to indwelling catheter replacement before initiating antimicrobial therapy or no replacement. Urine and blood cultures were done before antimicrobial therapy began. Clinical and microbiological outcomes were assessed after 3 days of therapy, and 7 and 28 days after therapy was complete.
  
  
  RESULTS
  Enrolled in our study were 21 male and 33 female nursing home residents with a mean age of 72.6 years, a chronic indwelling catheter and a clinical diagnosis of urinary tract infection. A total of 27 cases were randomized to either catheter replacement and no replacement before antimicrobial therapy. Polymicrobial bacteriuria significantly decreased 3 days after therapy was initiated, and 7 and 28 days after it was discontinued in 24 versus 8 (p = 0.002), 18 versus 9 (p = 0.01) and 13 versus 5 (p = 0.02) patients with and without catheter replacement, respectively. Catheter replacement was also associated with a shorter time to afebrile status, improved clinical status 72 hours after the initiation of therapy in 25 versus 11 patients (p <0.001) and a lower rate of symptomatic clinical relapse 28 days after therapy in 3 versus 11 (p = 0.015).
  
  
  CONCLUSIONS
  Clinical and bacteriological outcomes are improved when long-term indwelling catheters are replaced before initiating antimicrobial therapy for symptomatic urinary tract infection.
authors.affiliation: Infectious Diseases Unit and Technion, Faculty of Medicine, Haifa and Mishlav Long-Term Care Faculty, Afula, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Raz
authors.forename: D
authors.initials: D
authors.lastname: Schiller
authors.forename: L E
authors.initials: LE
authors.lastname: Nicolle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*
chemical_list: D000890:Anti-Infective Agents