Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysisBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3147 (Published 11 June 2013) Cite this as: BMJ 2013;346:f3147
- Jonas Marschall, internist and infectious disease specialist12,
- Christopher R Carpenter, internist and emergency medicine specialist3,
- Susan Fowler, medical librarian4,
- Barbara W Trautner, internist and infectious disease specialist56
- for the CDC Prevention Epicenters Program
- 1Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO 63110, USA
- 2Department of Infectious Diseases, Bern University Hospital and University of Bern, Friedbühlstrasse 51, CH-3010 Bern, Switzerland
- 3Emergency Care Research Section, Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
- 4Bernard Becker Medical Library, Washington University, St Louis, MO, USA
- 5Houston VA Health Services Research and Development Center of Excellence, Michael E DeBakey VA Medical Center, Houston, TX, USA
- 6Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Correspondence to: J Marschall
- Accepted 13 May 2013
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.
We thank Afke Brandenburg, Leeuwarden, Netherlands, for providing additional details for their study, and Graham Colditz, Division of Public Health Sciences, Washington University in St Louis, for his review of the analyses.
Contributors: JM and BWT designed the study. JM and SF did the literature search. JM and BWT reviewed studies with regard to inclusion/exclusion criteria and identified the studies that were eventually included in this meta-analysis. JM and CRC assessed the quality of included studies. JM, CRC, and BWT analyzed the data. JM wrote the draft manuscript with input regarding the study methodology from SF and CRC. All authors reviewed the final manuscript critically and authorized the submission. JM is guarantor.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. BWT was funded during the time of manuscript preparation by a VA Career Development Award from rehabilitation research and development (B4623), by VA HSR&D IIR 09-104, and NIDDK R21 092293. BWT’s work is also partially supported by the resources and facilities at the Houston VA Health Services Research and Development Center of Excellence (HFP90-020) at the Michael E DeBakey VA Medical Center. JM received support from the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) award through the NIH NCATS, a career development award (5K12HD001459-13). He is also the section leader for a subproject of the CDC Prevention Epicenters Program grant (U54 CK000162; PI Fraser). In addition, JM is funded by the Barnes-Jewish Hospital Patient Safety and Quality Fellowship Program and by a research grant from the Barnes-Jewish Hospital Foundation and Washington University’s Institute for Clinical and Translational Science.
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.
Ethical approval: Not required. Because we did not have access to protected health information from patients included in the analyzed studies, review by the Human Research Protection Office at Washington University was not required.
Data sharing: No additional data are available.
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