Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis

Jonas Marschall, Christopher R Carpenter, Susan Fowler, Barbara W Trautner, CDC Prevention Epicenters Program, Jonas Marschall, Christopher R Carpenter, Susan Fowler, Barbara W Trautner, CDC Prevention Epicenters Program

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.:

Design: 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.

Inclusion criteria: 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.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790815/bin/marj010745.f1_default.jpg
Fig 1 Selection of studies for meta-analysis of trials investigating antibiotic prophylaxis for urinary tract infections after removal of urinary catheter
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790815/bin/marj010745.f2_default.jpg
Fig 2: Forest plot of seven included studies with 1520 participants on effect of antibiotic prophylaxis on urinary tract infections after removal of urinary catheter
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790815/bin/marj010745.f3_default.jpg
Fig 3 Funnel plot of seven included studies with 1520 participants on effect of antibiotic prophylaxis on urinary tract infections after removal of urinary catheter

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Source: PubMed

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