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Antibiotics Prevent Some Hospital UTIs

Authors see benefit of treatment during catheter removal (June 20)

Urinary tract infections (UTIs) are among the most common infections acquired in hospitals. Most are linked to catheters that drain urine from the bladder, providing a direct route for bacteria to enter.

A new report by researchers at Washington University School of Medicine in St. Louis and at Baylor College of Medicine in Houston suggests that some UTIs could be prevented if patients were to receive antibiotics when they have urinary catheters removed.

Their findings were published in the British Medical Journal.

The report, a meta-analysis, pooled data from clinical trials involving more than 1,000 patients. Overall, the researchers found that giving antibiotics to catheterized patients reduced the risk of a UTI by nearly 6% compared with giving placebo. But the authors caution that more research is needed to evaluate whether the costs of prescribing antibiotics and other potential downsides outweigh the benefits of antibiotics in catheterized patients.

“Avoiding urinary tract infections in the hospital is desirable, but we need to look at the big picture,” said lead author Jonas Marschall, MD. “There’s a legitimate concern that widespread antibiotic use will encourage antibiotic resistance and cause side effects that include allergic reactions, drug toxicities, or the onset of C. difficile, an infection causing severe diarrhea.”

An estimated 20% of hospitalized patients get urinary catheters at some point during their stays. Most are surgery patients who have a catheter inserted for only a short time, typically a day or two. But the longer a patient is catheterized, the higher the risk of infection.

The analysis included seven studies, with some showing a benefit to giving antibiotics to catheterized patients while others did not. Each study evaluated whether antibiotics, compared with placebo, could reduce the risk of symptomatic UTIs in hospitalized patients who had urinary catheters inserted for 14 days or fewer. Five of the seven studies were in patients undergoing surgery.

Collectively, the studies included several types of antibiotics commonly prescribed to treat UTIs: ciprofloxacin and trimethoprim/sulfamethoxazole were used most frequently, followed by nitrofurantoin and cefotaxime. The treatment regimen varied in the studies from a single dose given at the time a catheter was removed to a 3-day course.

Source: Washington University in St. Louis; June 20, 2013.

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