Antibiotic prophylaxis benefits patients after extraction of urinary catheter: Study

A recent study found that patients in whom the urinary catheters are removed may benefit from antibiotic prophylaxis due to fewer consequent urinary tract infections. The study was published in "American Journal of Infection control" 2020.

Long term catheters in patients with urinary infections in home or hospital can cause potential infections and adverse effects. Antibiotic prophylaxis with Trimethoprim/sulfamethoxazole (TMP/SMX) in patients with advanced age and long term catheterization can be of great benefit. Researchers from Department of Urology, Institute of Urology West China Hospital, Sichuan University China conducted a study to investigate the effect of antibiotic prophylaxis for consequent urinary tract infections (UTIs) after extraction of urinary catheter and further explore the association between the outcome and clinical characteristics of patients.

The authors conducted a meta analysis using various databases through March 2020. They included the studies which inquired into antibiotic prophylaxis for UTIs after extraction of a temporary (≤14 days) urinary catheter. Fixed-effect models to obtain pooled risk ratio (RR) estimates were used and heterogeneity was evaluated with I2 value. To assess heterogeneity. sensitivity analysis and subgroup analysis were conducted.

The key findings of the analysis were:

• Eight randomized controlled trials were included.

• Only two studies showed that antibiotic prophylaxis can reduce the consequent UTIs after extraction of urinary catheters while six did not.

• Overall, antibiotic prophylaxis was associated with reduced UTIs (p<0.01 I2 = 31%).

• Subgroup analysis indicated that patients who are older than 60 or received Trimethoprim/sulfamethoxazole (TMP/SMX) or indwelling catheters for more than 5 days could get more benefit from antibiotic prophylaxis after extraction of catheters.

Thus the authors concluded that Patients with catheters removed might get benefit from antibiotic prophylaxis as a result of fewer consequent UTIs, and those who have advanced age (over 60 years old) or long-term catheterization (over 5 days) could get more benefit from prophylaxis. They further added that TMP/SMX could be a good choice of prophylaxis for UTIs after extraction of urinary catheters. They also suggested that this approach should apply to high-risk patients (advanced age or long-term catheterization) due to the potential harm of widespread antibacterial agents such as side effects and bacterial resistance. 

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