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| |  Risk of Urinary Tract Infection on Catheter Removal Is Not Reduced by Antibiotic Prophylaxis in Surgical Patients: Presented at ECCMID By Chris Berrie HELSINKI, Finland -- May 26, 2009 -- Antibiotic prophylaxis for urinary catheter removal provides no clinical benefits for patients undergoing surgery, according to a randomised, double-blind, placebo-controlled trial presented here at the 19th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). "In [our] hospital, they used to give prophylaxis for withdrawal of a urinary catheter," said Babette C. van Hees, MD, Department of Medical Microbiology and Infectious Diseases, Gelre Hospital, Apeldoorn, the Netherlands, on May 18. "Every [patient with a] catheter that was in place for 3 days or more [was given] ciprofloxacin the day before, the day of, and the day after removal, but we felt this might not be necessary." The study's aim was to assess the efficacy of therapy with a single dose of trimethoprim/sulfamethoxazole (cotrimoxazole) or ciprofloxacin (CIP) compared with placebo in surgical patients who were scheduled for bladder drainage for 3 to 14 days. Of the original 140 randomised surgery patients, researchers analysed results from 44 patients receiving placebo (mean age, 65.6 years; male, 64%), 37 receiving a single dose of cotrimoxazole 960 mg (mean age, 69.3 years; male, 54%), and 34 receiving a single dose of CIP 500 mg (mean age, 69.3; male, 44%). Primary outcome measures included pyuria and significant bacteriuria, immediately after and 12 to 14 days after catheter removal, and evidence of urinary tract infection (UTI), 12 to 14 days after catheter removal. Assessments included urine cultures and UTI symptom questionnaires. Directly after catheter removal, 37% of the placebo group showed pyuria and 35% showed significant bacteriuria. Whereas prophylaxis with cotrimoxazole had no significant effects (27% for both), the CIP had significant reductions to 15% (relative risk [RR], 0.41; 95% confidence interval [CI], 0.17-1.00; P = .03) and 9% (RR, 0.26; 95% CI, 0.08-0.83; P = .01), respectively. In contrast, at 2 weeks after catheter removal, significance differences were seen for pyuria (14%) and significant bacteriuria (33%) between the placebo and either the cotrimoxazole group (pyuria: 11%; RR, 0.80, 95% CI, 0.21-13.06; P = .74; significant bacteriuria: 19%; RR, 0.56; 95% CI, 0.22-1.39; P = .19) or the CIP group (pyuria: 7%; RR, 0.46; 95% CI, 0.10-2.23; P = .32; significant bacteriuria: 19%; RR, 0.58; 95% CI, 0.25-1.36; P = .20). Similar levels were seen for placebo (2.9%) and CIP (3.2%) in the UTI analysis; the reduction for cotrimoxazole (0.0%) did not reach significance (P = .40). The researchers concluded that, although CIP prophylaxis is effective in resolving asymptomatic bacteriuria immediately after catheter removal, it showed no significant benefits in reducing bacteriuria or the rate of UTI 2 weeks later. Because data for short-term or long-term adverse effects are lacking, the researchers concluded that antibiotic prophylaxis for urinary catheter removal does not need to be used, but Dr. van Hees also noted that the change in policy at their hospital contributed to reducing both the use of ciprofloxacin and ciprofloxacin resistance.
[Presentation title: Single-Dose Antibiotic Prophylaxis for Urinary Catheter Removal Does Not Reduce the Risk for Urinary Tract Infection in Surgical Patients: A Randomized Double-Blind Placebo-Controlled Trial. Abstract P1787]
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