Prophylactic antibiotics to prevent urinary tract infection during clean intermittent self-catheterization (CISC) for management of voiding dysfunction after prolapse and incontinence surgery: a decision analysis.
OBJECTIVE
The objective of this study is to estimate efficacy of prophylactic antibiotics in UTI prevention during CISC for postoperative voiding dysfunction after prolapse/incontinence surgery.


METHODS
We constructed a decision tree model to evaluate risks and benefits of prophylactic antibiotics during CISC for voiding dysfunction after prolapse/incontinence surgery. The model randomized women requiring CISC to prophylactic antibiotics or no prophylaxis. Probabilities for UTI after CISC with or without prophylactic antibiotics, sequelae from antibiotic use or UTI, and utility values were obtained from published literature and practice quality assurance reviews. Main outcome was probability of experiencing no UTI or adverse event.


RESULTS
Under baseline assumptions, prophylactic antibiotics were favored in both models. In the true UTI model, prophylactic antibiotics had an 83.1% probability of no UTI or adverse events; 16.1% better than no prophylactic antibiotics.


CONCLUSIONS
Using decision analysis methods, prophylactic antibiotics are favored for prevention of UTI during CISC to manage voiding dysfunction after prolapse/incontinence surgery.
Sutkin
Gary
G
Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh-School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA.
Lowder
Jerry L
JL
Smith
Kenneth J
KJ
D019072:Antibiotic Prophylaxis; D002404:Catheterization / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D012648:Self Care; D014549:Urinary Incontinence / Q000601:surgery; D016055:Urinary Retention / Q000628:therapy*; D014552:Urinary Tract Infections / Q000517:prevention & control*; D014596:Uterine Prolapse / Q000601:surgery