Intervention Review

Antibiotic prophylaxis for short-term catheter bladder drainage in adults

  1. Gail Lusardi1,*,
  2. Allyson Lipp1,
  3. Christine Shaw2

Editorial Group: Cochrane Incontinence Group

Published Online: 3 JUL 2013

Assessed as up-to-date: 31 OCT 2012

DOI: 10.1002/14651858.CD005428.pub2

How to Cite

Lusardi G, Lipp A, Shaw C. Antibiotic prophylaxis for short-term catheter bladder drainage in adults. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD005428. DOI: 10.1002/14651858.CD005428.pub2.

Author Information

  1. 1

    Department of Care Sciences, University of South Wales, Faculty of Health, Sport and Science, Pontypridd, UK

  2. 2

    Department of Care Sciences, University of South Wales,, Faculty of Health, Sport and Science, Rhondda Cynon Taff, UK

*Gail Lusardi, Faculty of Health, Sport and Science, Department of Care Sciences, University of South Wales, Glyntaff, Pontypridd, CF37 1DL, UK. glusardi@glam.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 3 JUL 2013

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 prophylaxes are better than others in terms of prevention of urinary tract infections, complications, quality of life and cost-effectiveness in short-term catheterisation in adults.

Search methods

We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, and handsearching of journals and conference proceedings (searched 31st October 2012). Additionally, we examined all reference lists of identified trials.

Selection criteria

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

Data collection and analysis

Data were independently extracted by all review authors and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systemtic Reviews of Interventions. Where data had not been fully reported, clarification was sought directly from the authors of the trial.

Main results

Six parallel-group randomised controlled trials with 789 participants met the inclusion criteria. All six trials compared antibiotic prophylaxis versus no prophylaxis. Studies presented a low to unclear risk of bias with similar interventions and measured outcomes.

The primary outcome of bacteriuria was less common in the prophylaxis group amongst surgical patients with asymptomatic bacteriuria (I2 = 0; risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) . Two non-surgical studies could not be combined in a meta-analysis due to heterogeneity and only one showed significantly fewer cases of bacteriuria (RR 0.19; 95% CI 0.09 to 0.37).

Two trials of surgical patients with asymptomatic bacteriuria only (255 participants) compared one type of antibiotic prophylaxis with another and neither study showed a significant difference in cases of bacteriuria.

One study (78 participants) compared antibiotic prophylaxis in patients at catheterisation only versus antibiotic prophylaxis throughout catheterisation period with asymptomatic bacteriuria. Antibiotics at catheterisation only, resulted in significantly fewer cases of bacteriuria than giving prophylaxis throughout the catheterisation period (RR 0.29 95% CI 0.09 to 0.91).

Secondary data of pyuria were provided by two surgical studies (255 participants). When studies were pooled, pyuria occurred in significantly fewer cases in the prophylactic antibiotic group (RR 0.23, 95% CI 0.13 to 0.42). The number of gram-negative isolates in patients' urine just before catheter removal in one study (RR 0.05, 95% CI 0.00 to 0.79) and six weeks after hospital discharge (RR 0.36, 95% CI 0.23 to 0.56) were significantly lower. There were no events in the treatment group before catheter removal. When pooled data from two studies showed significantly reduced febrile morbidity in those receiving antibiotic prophylaxis (RR 0.53 95% CI 0.31 to 0.89).

Although all studies assessed micro-organisms isolated from the urine specimens the data were too heterogenous to pool in a meta-analysis and have been provided in a narrative form. Further secondary data such as economic analysis, length of stay and quality of life were not covered in detail.

Authors' conclusions

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antibiotic prophylaxis for short-term catheter bladder drainage in adults

Catheters may be used to drain urine from the bladder in hospital for short periods of time (less than two weeks). This may cause a urinary 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 concerning the chance of allergic reactions or other side effects from the antibiotics. Antibiotic-resistant bacteria were identified in most studies but there was no definite link made to the use of antibiotics.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

成人短期插尿管的抗生素使用策略

泌尿道感染約佔了院內感染總數的40%,而約有80%的院內泌尿道感染與尿館的置放有關。

目標

決定是否存在特定的抗生素,對於必須短期插上尿管的病人,有較佳的預防感染效果,避免併發症改善生活品質且有符合經濟效益。

搜尋策略

搜尋資料庫:Cochrane Incontinence Group Specialised Register自從2006年5月29日,另外也參考了所有trial的reference lists。

選擇標準

選擇了比較在有放置尿管的病人,短期的抗生素使用策略(長至14天),所有的trial均是隨機或是準隨機的。

資料收集與分析

資料被兩位學者獨立的搜集及比較,而意見分歧的部分均以討論過後獲得共識。資料處理的過程在Cochrane Handbook中有敘述。敘述不足的部分,作者均有在內文中予以澄清。

主要結論

共有6個相似的隨機控制實驗符合搜尋的條件。在一個研究中,針對外科住院女性患者且需要24小時以上的尿管放置,比較了有給予預防性抗生素及臨床上有適應症再給予的兩個族群,發現具有症狀的泌尿道感染在有事先給予預防性抗生素的族群較為少見。另外5個研究則比較了給予預防性抗生素及微生物證據上有抗生素的適應症才給予抗生素的兩個族群,結果在給予預防性抗生素的族群,有較少的菌尿、膿尿及尿中格蘭氏陰性菌的分離。菌尿的發生率在有給予預防性抗生素族群中少了5倍(且包含了無論是有無接受手術的病人)。但目前無比較有維生物證據及臨床症狀有適應症才給抗生素的這兩個族群。

作者結論

目前只有微弱的證據顯示,相較於臨床有證據才給予抗生素,預防性抗生素給予在接受腹部手術且術後須放置尿管24小時以上的患者中,能降低有症狀的泌尿道感染。而只有有限的證據顯示,術後須放置尿管24小時以上的病人,術後3天或是從術後第二天至尿管移除接受預防性抗生素,能降低膿尿、尿中格蘭氏陰性菌的分離等徵候。另外也只有有限的證據顯示預防性抗生素在非手術的病人身上可有效減少菌尿。

翻譯人

本摘要由中國醫藥大學附設醫院張維君翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

短期的導尿管放置(小於2星期)是醫院內常見用來引流膀胱中尿液的方法。這個行為可能造成尿道感染或是尿液中的菌落數增加,這個review發現在有導尿管放置的病人中,給予預防性抗生素(無論是尿管放置前或是中)有較少感染的機會及尿中菌落數較少且較少在尿中發現化膿。但目前並無證據討論預防性抗生素造成過敏反應,帶來菌種抗藥性或其他不良反應等負面效應。