title: Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis.
abstract: OBJECTIVE
  To determine whether antibiotic prophylaxis at the time of removal of a urinary catheter reduces the risk of subsequent symptomatic urinary tract infection.:
  
  
  METHODS
  Systematic review and meta-analysis of studies published before November 2012 identified through PubMed, Embase, Scopus, and the Cochrane Library; conference abstracts for 2006-12 were also reviewed.
  
  
  METHODS
  Studies were included if they examined antibiotic prophylaxis administered to prevent symptomatic urinary tract infection after removal of a short term (≤ 14 days) urinary catheter.
  
  
  RESULTS
  Seven controlled studies had symptomatic urinary tract infection after catheter removal as an endpoint; six were randomized controlled trials (five published; one in abstract form) and one was a non-randomized controlled intervention study. Five of these seven studies were in surgical patients. Studies were heterogeneous in the type and duration of antimicrobial prophylaxis and the period of observation. Overall, antibiotic prophylaxis was associated with benefit to the patient, with an absolute reduction in risk of urinary tract infection of 5.8% between intervention and control groups. The risk ratio was 0.45 (95% confidence interval 0.28 to 0.72). The number needed to treat to prevent one urinary tract infection was 17 (12 to 30).
  
  
  CONCLUSIONS
  Patients admitted to hospital who undergo short term urinary catheterization might benefit from antimicrobial prophylaxis when the catheter is removed as they experience fewer subsequent urinary tract infections. Potential disadvantages of more widespread antimicrobial prophylaxis (side effects and cost of antibiotics, development of antimicrobial resistance) might be mitigated by the identification of which patients are most likely to benefit from this approach.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO 63110, USA. jmarscha@dom.wustl.edu
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Carpenter
authors.forename: Susan
authors.initials: S
authors.lastname: Fowler
authors.forename: Barbara W
authors.initials: BW
authors.lastname: Trautner
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology*; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D014546:Urinary Catheterization / Q000009:adverse effects*; D062885:Urinary Catheters / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*