A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in catheterized ICU patients.
OBJECTIVE
To determine the effect on the occurrence of urosepsis of a treatment with a short course of antibiotics and indwelling urethral catheter replacement in clinically asymptomatic intensive care unit (ICU) patients with a positive urine culture occurring at least 48 h after catheterization.


METHODS
A prospective randomized clinical trial was conducted in the medico-surgical ICU of a tertiary care centre. Sixty patients hospitalized in the ICU with an indwelling urethral catheter for longer than 48 h developing an asymptomatic positive urine culture were randomized to receive either a 3-day course of antibiotics associated with the replacement of the indwelling urethral catheter 4 h after first antibiotic administration or no antibiotics, no catheter replacement (standard of care).


RESULTS
Three patients in each group developed urosepsis (P=0.1). There were no significant differences in duration of mechanical ventilation between the study group and the standard of care group (9 [4-20] days vs 5 [2-15] days, P=0.2), in duration of urinary catheterization (22 [11-40] days vs 18 [14-33] days, P=0.8), or in length of ICU stay (28 [13-46] vs 19 [15-34], P=0.6). The recurrence of positive urine culture at days 7 and 15 was not affected by the randomization (P=0.1). The profile of bacterial resistance was similar in the two groups.


CONCLUSIONS
Treating a positive urine culture in an asymptomatic patient with an indwelling urethral catheter does not reduce the occurrence of urosepsis in the medico-surgical ICU.
Leone
Marc
M
Département d'Anesthésie et de Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, 13915, Marseille cedex 20, France. marc.leone@ap-hm.fr
Perrin
Anne-Sophie
AS
Granier
Isabelle
I
Visintini
Pierre
P
Blasco
Valery
V
Antonini
François
F
Albanèse
Jacques
J
Martin
Claude
C
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001437:Bacteriuria / Q000188:drug therapy* / Q000209:etiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D014546:Urinary Catheterization / Q000009:adverse effects*
D000900:Anti-Bacterial Agents