Is there a role for prophylactic antibiotics in the prevention of urinary tract infections following Foley catheter removal in patients having abdominal surgery?

Is there a role for prophylactic antibiotics in the prevention of urinary tract infections following Foley catheter removal in patients having abdominal surgery?

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C. Suzanne Cutter, MD; Steven R. Kelly, MD; Peter W. Marcello, MD; John E. Mahoney, MD; Lindsay E. Nicolle, MD; Robin S. McLeod, MD for the Members of the Evidence Based Reviews in Surgery Group

The CAGS/ACS Evidence Based Reviews in Surgery Group comprises Drs. N.N. Baxter, K.J. Brasel, C.J. Brown, P. Chaudhury, C.S. Cutter, C.M. Divino, E. Dixon, L. Dubois, G.W.N. Fitzgerald, H.J.A. Henteleff, A.W. Kirkpatrick, S. Latosinsky, A.R. MacLean, T.M. Mastracci, R.S. McLeod, A.M. Morris, L.A. Neumayer, L.K. Temple and Ms. M.E. McKenzie.

The term “evidence-based medicine” was first coined by Sackett and colleagues as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”1 The key to practising evidence-based medicine is applying the best current knowledge to decisions in individual patients. Medical knowledge is continually and rapidly expanding. For clinicians to practise evidence-based medicine, they must have the skills to read and interpret the medical literature so that they can determine the validity, reliability, credibility and utility of individual articles. These skills are known as critical appraisal skills, and they require some knowledge of biostatistics, clinical epidemiology, decision analysis and economics, and clinical knowledge.

Evidence Based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS) and is supported by an educational grant from ETHICON and ETHICON ENDO-SURGERY, both units of Johnson & Johnson Medical Products, a division of Johnson & Johnson and ETHICON Inc. and ETHICON ENDO-SURGERY Inc., divisions of Johnson & Johnson Inc. The primary objective of EBRS is to help practising surgeons improve their critical appraisal skills. During the academic year, 8 clinical articles are chosen for review and discussion. They are selected for their clinical relevance to general surgeons and because they cover a spectrum of issues important to surgeons, including causation or risk factors for disease, natural history or prognosis of disease, how to quantify disease, diagnostic tests, early diagnosis and the effectiveness of treatment. A methodological article guides the reader in critical appraisal of the clinical article. Methodological and clinical reviews of the article are performed by experts in the relevant areas and posted on the EBRS website, where they are archived indefinitely. In addition, a listserv allows participants to discuss the monthly article. Surgeons who participate in the monthly packages can obtain Royal College of Physicians and Surgeons of Canada Maintenance of Certification credits and/or continuing medical education credits for the current article only by reading the monthly articles, participating in the listserv discussion, reading the methodological and clinical reviews and completing the monthly online evaluation and multiple choice questions.

We hope readers will find EBRS useful in improving their critical appraisal skills and in keeping abreast of new developments in general surgery. Four reviews are published in condensed versions in the Canadian Journal of Surgery and 4 are published in the Journal of the American College of Surgeons. For further information about EBRS, please refer to the CAGS or ACS websites. Questions and comments can be directed to the program administrator, Marg McKenzie, at mmckenzie@mtsinai.on.ca.

Reference

1. Evidence-Based Medicine Working Group. Evidence-based medicine. JAMA 1992;268:2420-5.


Selected Article

Pfefferkron U, Sanlav L, Mouldenhauer J, et al. Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infections. A prospective randomized trial. Ann of Surg 2009;249:573–75.

Abstract

Question: Does the use of antibiotic prophylaxis at urinary catheter removal reduce the rate of urinary tract infection? Design: Randomized controlled trial. Setting: Single centre in Basel, Switzerland. Patients: A total of 239 patients between January 2005 and September 2007 were randomly assigned into 2 groups by an online randomization generator. Intervention: Patients undergoing elective abdominal surgery with planned perioperative urethral catheterization were assigned at admission to receive either 960 mg of trimethoprim-sulfamethoxazole orally the night before and twice on the day of catheter removal or no antibiotic prophylaxis. Urinary cultures were obtained before and 3 days after catheter removal. Main outcome measures: Occurrence of symptomatic urinary tract infection (based on the Centers for Disease Control and Prevention definitions) after catheter removal. Results: Patients who received antibiotic prophylaxis experienced significantly fewer urinary tract infections than those who did not (5 of 103 [4.9%] v. 22 of 102 [21.6%], p < 0.001; number needed to treat 6). Patients who received antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal than those who did not (17 of 103 [16.5%] v. 42 of 102 [41.2%], p < 0.001). Conclusion: Antibiotic prophylaxis with trimethoprim-sulfamethoxazole at the time of urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients who undergo abdominal surgery and perioperatively receive transurethral urinary catheters.


Competing interests: None declared.

DOI: 10.1503/cjs.009911

Correspondence to: Ms. Marg McKenzie, RN, Administrative Coordinator, EBRS, Mount Sinai Hospital, L3-010, 60 Murray St., PO Box 23, Toronto ON M5T 3L9 fax 416 586-5932 mmckenzie@mtsinai.on.ca