Short-Term Versus Prolonged Systemic Antibiotic Prophylaxis in Patients Treated with Indwelling Catheters

Abstract

Newly hospitalized patients with stroke treated by indwelling catheters were assigned randomly to 3 treatment groups. Group 1 (24 patients) received 3 gm. ampicillin intramuscularly in divided doses 1 hour before, at the time of and 6 hours after insertion of the catheter. Group 2 (28 patients) received daily 1 gm. ampicillin intramuscularly every 8 hours. Group 3 (26 patients) was not subjected to any antimicrobial prophylaxis. Within 1 week after catheter insertion significant bacteriuria developed in 12.5 per cent of the patients in group 1, 42.8 per cent in group 2 and 45.1 per cent in group 3. The difference in the incidence between group 1 and either group 2 or 3 was statistically significant (p less than 0.02 and p less than 0.01, respectively). The mean number of strains (plus or minus standard error of mean) isolated per case of bacteriuria in group 3 (1.25 plus or minus 0.18) was significantly lower (p less than 0.05) and antimicrobial resistant strains were fewer (4 of 15) than in group 2 (1.75 plus or minus 0.13 and 12 of 21, respectively).

Complicated Urinary Tract Infection in Adults

“…Clinical trials of prophylactic antimicrobial therapy suggest this approach is ultimately unsuccessful due to reinfection with resistant organisms. Prospective, randomized trials of prophylactic antimicrobial therapy have been reported for patients with short-term indwelling catheters (110)(111)(112) and spinal cord injury patients (113,114). While a decrease in the frequency of symptomatic infection may initially occur, emergence of resistant organisms ultimately limits efficacy (111,113).…”

Preventing Catheter-Related Bacteriuria

“…21 In general, systemic antibiotic drug therapy tends to be most useful in patients requiring urinary catheterization for 3 to 14 days. 21,[68][69][70][71][72][73] Those catheterized for shorter durations are not at high enough risk *Number of patients who developed bacteriuria/total number of participants assigned to each group. †Odds of developing bacteriuria in the silver-coated catheter vs control catheter groups; CI indicates confidence interval.…”

Prophylactic single-dose prulifloxacin for catheter-associated urinary tract infection after tension-free vaginal tape procedure

“…Measures directed toward the latter objective include the use of prophylactic systemic antibiotics. The value of chemoprophylaxis in lowering the incidence of UTIs in short-term catheterized patients is controversial [5][6][7][8][9]. A weak evidence from randomized trials indicates that receiving prophylactic antibiotics reduces the frequency of bacteriuria and other signs of infection (pyuria or gram-negative isolates) in surgical patients by about fourfold [5].…”

“…However, because morbidity from UTI with short-term catheter use is usually limited and concerns have been raised on the dramatic increase in antimicrobial resistance due to unnecessary exposure of bacteria to antibiotics, the benefit of chemoprophylaxis as infection control measure was questioned. Moreover, the issue of patient tolerance, adverse drug reactions, and side effects has not been adequately addressed in trials comparing antibiotic policies for short-term catheterization [5][6][7][8][9].…”