Antibiotic Prophylaxis After Urinary Catheter Removal Lowers Risk for Symptomatic Urinary Tract Infection

But widely applied, this practice undoubtedly would lead to antibiotic-associated adverse events and antibiotic resistance.

Urinary catheterization, which is common in hospitalized patients, is associated with symptomatic urinary tract infections (UTIs). In a meta-analysis of seven trials (6 randomized and 1 nonrandomized) that involved 1520 patients (mostly postsurgical) who underwent short-term catheterization (≤14 days), investigators determined whether administering antibiotic prophylaxis at the time of urinary catheter removal lowers risk for symptomatic UTI.

In all trials, researchers compared antibiotic prophylaxis versus placebo or usual care. Antibiotics used were ciprofloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, and cefotaxime. Duration of antibiotic prophylaxis ranged from single doses to 3 days. Symptomatic UTIs occurred in 10.5% of control patients and in 4.7% of prophylaxis patients. Hence, antibiotic prophylaxis resulted in a 5.8% absolute risk reduction for symptomatic UTI (number needed to treat to prevent 1 symptomatic UTI, 17).

Comment

Although these results suggest that antibiotic prophylaxis at the time of urinary catheter removal prevents symptomatic UTIs, clinicians should be wary of applying these results broadly. If every hospitalized patient with a urinary catheter received prophylaxis, antibiotic use would increase markedly, which undoubtedly also would increase adverse events (e.g., antibiotic-associated side effects, Clostridium difficile infections), antibiotic resistance, and costs.

Reviewing Author

Paul S. Mueller, MD, MPH, FACP

Disclosures

Nothing to disclose