Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infections: a prospective randomized trial.
OBJECTIVE
To assess whether antibiotic prophylaxis at urinary catheter removal reduces the rate of urinary tract infections.


BACKGROUND
Urinary tract infections are among the most common nosocomial infections. Antibiotic prophylaxis at urinary catheter removal is used as a measure to prevent them, albeit without supporting evidence.


METHODS
A prospective randomized study enrolled 239 patients undergoing elective abdominal surgery, who were randomized either for receiving 3 doses of trimethoprim-sulfamethoxazole at urinary catheter removal, or not. Urinary tract infections were diagnosed according to Center of Disease Control definitions. Urinary cultures were obtained before and 3 days after catheter removal. Subjective symptoms were assessed by an independent study-blind urologist.


RESULTS
Patients who received antibiotic prophylaxis showed significantly fewer urinary tract infections (5/103, 4.9%) than those without prophylaxis (22/102, 21.6%), P < 0.001. The absolute risk reduction for the occurrence of a urinary tract infection was 16.7%; the relative risk reduction was 77.5%, and the number needed to treat was 6. Patients with antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal (17/103, 16.5%) than those without (42/102, 41.2%), P < 0.001.


CONCLUSIONS
Antibiotic prophylaxis with trimethoprim-sulfamethoxazole on urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients undergoing abdominal surgery with perioperative transurethral urinary catheters.
Pfefferkorn
Urs
U
Department of Surgery, St. Claraspital, Basel, Switzerland. urs.pfefferkorn@gmail.com
Lea
Sanlav
S
Moldenhauer
Jörg
J
Peterli
Ralph
R
von Flüe
Markus
M
Ackermann
Christoph
C
D000368:Aged; D019072:Antibiotic Prophylaxis; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D016001:Confidence Intervals; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*; D014546:Urinary Catheterization / Q000379:methods; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*
D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination