A pilot study on prevention of catheter-related urinary tract infections with fluoroquinolones. Prophylactic ciprofloxacin for catheter-associated urinary-tract infection. Short-term versus prolonged systemic antibiotic prophylaxis in patients treated with indwelling catheters. Antimicrobial prophylaxis for catheter-associated bacteriuria. A single dose of aztreonam in the prevention of urinary tract infections in elderly catheterized patients. Prophylactic single-dose co-trimoxazole for prevention of urinary tract infection after abdominal hysterectomy.
The objective of this multicenter, randomized, controlled, parallel group trial was to evaluate the efficacy of levofloxacin 250 mg oral, once daily (LVFX), placebo one tablet oral once daily (Placebo [P] group) and ciprofloxacin (CPFX) 500 mg oral, twice daily (single blind), prophylaxis in preventing bacteriuria (> or = 10(3) CFU/ml) in post-surgical catheterized patients. In the modified intention-to-treat (M-ITT) population of the 82 enrolled patients, negative bacteriuria was observed in 92% of LVFX group, in 80% of P group and in 100% of CPFX group while in the per-protocol (PP) population figures were: 100%, 86.4% and 100% respectively. Only one symptomatic urinary tract infection and one surgical wound infection were observed in the P group. Both drugs were well tolerated, showing a safety profile comparable to placebo. The high frequency of negative bacteriuria in the placebo group sounds encouraging as it underlines that the adoption of closed urinary drainage system catheters in hospital setting may reduce the frequency of hospital-acquired infections. Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n = 59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% CI] 4.7 [3.0-7.4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4.0 [2.1-7.3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4.0 [1.6-10.2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Enterococcus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage. 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). We evaluated short-term systemic antimicrobial prophylaxis for catheter-associated bacteriuria in women undergoing elective gynecological operations in a prospective, controlled, double-masked study. Nine of 100 placebo-treated patients acquired bacteriuria during catheterization compared with 3 of 96 of the drug-treated group. However, at the time of hospital discharge, clean-voided urine specimens were positive as frequently in the drug-treated group (8 of 82 patients cultured) as in the placebo group (8 of 75 patients cultured). No difference in febrile morbidity due to bacteriuria was noted between the prophylaxis and placebo groups. The incidence of catheter-associated bacteriuria may be reduced by antimicrobial prophylaxis. However, because the protective effect is transient and is associated with the selection of resistant organisms, prophylaxis is not indicated for patients at low risk for acquired bacteriuria and in whom the sequelae of catheter-associated infections are infrequent. We have compared the effects of aztreonam and placebo in the prevention of urinary tract infections (UTI) in elderly hospitalized patients who needed urethral catheterization. 162 patients (96 males, 66 females; age range 60-91 years) were randomly allocated to receive double-blind a single dose of aztreonam (2 g i.m. 80 patients) or placebo (4 ml lidocaine 2%, 82 patients) three hours before catheterization. All patients were followed-up for 7 days. Urine culture was performed before, at the first, third and seventh day of catheterization. At the end of follow-up 71/80 patients (88.7%) who received a single preventing dose of aztreonam had negative urine culture without clinical signs of UTI. On the contrary, in the group treated with placebo at the end of follow-up only 38/82 patients (46.3%) had negative urine without clinical signs of UTI. In conclusion, our data suggest that a single 2g i.m. dose of aztreonam is effective in preventing UTI in elderly patients needing indwelling urethral catheterization. The efficacy of a preoperative single-dose of co-trimoxazole in reducing postoperative urinary tract infection and febrile morbidity after abdominal hysterectomy was evaluated in a randomized placebo-controlled study of 90 patients undergoing surgery. Among the co-trimoxazole patients, 6.2% developed urinary tract infection compared to 31% in the placebo group (p less than 0.001) and 12.5% febrile morbidity compared to 38% in the placebo patients (p less than 0.025). No adverse side effects of co-trimoxazole were observed and this regimen seems both safe and effective.
The limited evidence indicated that receiving prophylactic antibiotics reduced the rate of bacteriuria and other signs of infection, such as pyuria, febrile morbidity and gram-negative isolates in patients' urine, in surgical patients who undergo bladder drainage for at least 24 hours postoperatively. There was also limited evidence that prophylactic antibiotics reduced bacteriuria in non-surgical patients.