Am J Infect Control. 2020 Aug 4:S0196-6553(20)30759-8. doi: 10.1016/j.ajic.2020.07.034. Online ahead of print.
OBJECTIVE: 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.
METHODS: We systematically searched PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov databases through March 2020. Studies were included if they inquired into antibiotic prophylaxis for UTIs after extraction of a temporary (≤14 days) urinary catheter. We used fixed-effect models to obtain pooled risk ratio (RR) estimates. Heterogeneity was evaluated with I2 value. Sensitivity analysis and subgroup analysis were also conducted to assess heterogeneity.
RESULTS: We finally included eight randomized controlled trials in our study. 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 (RR, 0.47, 95% CI 0.28 to 0.72, p<0.01, I2 = 31%). Subgroup analysis indicated that patients who are older than 60 (RR = 0.50, 95% CI: 0.33 to 0.76, p < 0.05, I2 = 29%) or received Trimethoprim/sulfamethoxazole (TMP/SMX) (RR = 0.21, 95% CI: 0.09 to 0.48, p < 0.01, I2 = 0%) or indwelling catheters for more than 5 days (RR = 0.34, 95% CI: 0.19 to 0.63, p < 0.01, I2 = 0%) could get more benefit from antibiotic prophylaxis after extraction of catheters.
CONCLUSIONS: 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. And TMP/SMX could be a good choice of prophylaxis for UTIs after extraction of urinary catheters. 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.