Antibiotic policies for short-term catheter bladder drainage in adults

Niël-Weise BS, van den Broek PJ

Published Online:

January 21, 2009

Catheters may be used to drain the bladder in hospital for short periods of time (less than two weeks). This may cause a urine infection, or an increase in the number of bacteria in the urine. The review found that people who had antibiotics before or during catheter use were less likely to have an infection, and less likely to have a large number of bacteria or pus cells in the urine. However, there was no evidence about the chance of allergic reactions or other side effects from the antibiotics, nor about the chance of developing bacteria with antibiotic resistance.

Abstract (click to read)

Background:

Urinary tract infections account for about 40% of hospital-acquired (nosocomial) infections, and about 80% of urinary tract infections acquired in hospital are associated with urinary catheters.

Objectives:

To determine if certain antibiotic policies are better than others in terms of prevention of urinary tract infections, complications, quality of life and cost-effectiveness in short-term catheterised adults.

Search strategy:

We searched the Cochrane Incontinence Group Specialised Register (searched 29 May 2006). Additionally, we examined all reference lists of identified trials.

Selection criteria:

All randomised and quasi-randomised trials comparing antibiotic policies for short-term (up to and including 14 days) catheterization in adults.

Data collection and analysis:

Data were extracted by both reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If data had not been fully reported, clarification was sought directly from the authors of the trial.

Main results:

Six parallel-group randomised controlled trials met the inclusion criteria.

In one trial comparing antibiotic prophylaxis with giving antibiotics when clinically indicated amongst female surgical patients who had a urethral catheter for more than 24 hours, symptomatic urinary tract infection was less common in the prophylaxis group (RR 0.20, 95% CI 0.06 to 0.66).

Five trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated, bacteriuria, pyuria and gram-negative isolates in patients' urine were less common in the prophylaxis group amongst surgical patients with bladder drainage for at least 24 hours postoperatively. Bacteriuria rates were also about five-fold lower in the prophylaxis group in trials involving urological surgery patients and non-surgical patients.

No trial compared giving antibiotics when microbiologically indicated with giving antibiotics when clinically indicated.

Authors' conclusions:

There was weak evidence that antibiotic prophylaxis compared to giving antibiotics when clinically indicated reduced the rate of symptomatic urinary tract infection in female patients with abdominal surgery and a urethral catheter for 24 hours.

The limited evidence indicated that receiving antibiotics during the first three postoperative days or from postoperative day two until catheter removal reduced the rate of bacteriuria and other signs of infection such as pyuria and gram-negative isolates in patients urine in surgical patients with bladder drainage for at least 24 hours postoperatively. There was also limited evidence that prophylactic antibiotics reduced bacteriuria in non-surgical patients.

This record should be cited as:

Niël-Weise BS, van den Broek PJ. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD005428. DOI: 10.1002/14651858.CD005428

Assessed as up to date:

May 29, 2006

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Primary Review Group:

Incontinence Group

Health topics:

Gynaecology > Urinary incontinence > Drug treatment

Gynaecology > Urinary incontinence > Mechanical treatment

Gynaecology > Urinary incontinence > Prevention

Urology > Incontinence > Drug treatment

Urology > Incontinence > Mechanical treatment