Administering antibiotic prophylaxis at the time of catheter removal following urologic surgery can reduce re-hospitalization for febrile urinary tract infection (UTI), investigators reported at the American Urological Association’s (AUA) 2023 Annual Scientific Meeting in Chicago, Illinois.
Clinicians typically insert a urethral catheter for up to 5 days after most urological procedures, such as ureteroscopy, transurethral resection of the prostate (TURP), or transurethral resection of the bladder tumor (TURBT).
Investigators randomly assigned 211 patients (age 67 years; 80%-82% male) undergoing elective urologic surgery to an antibiotic prophylaxis or control group. Treated patients received 500 mg oral cefuroxime axetil 1 hour before catheter removal. If patients had penicillin allergy or cefuroxime-resistant bacteria, they alternately received trimethoprim/sulfamethoxazole (160/800 mg).
Readmissions due to febrile UTI were significantly lower in the antibiotic prophylaxis than control group: 1.0% vs 7.3%, Omri Schwarztuch Gildor, MD, of Meir Medical Center in Kfar-Saba, Israel, reported on behalf of his team. A significantly lower proportion of treated patients reported dysuria at 1 month (17.8% vs 34.4%). The groups had similar characteristics at baseline, such as medical history, preoperative culture, and operation type. A third of both groups had diabetes, which increases risk of UTI. Less than a third of both groups had positive preoperative urine culture and received preoperative antibiotics.
The investigators observed no differences in 30-day adverse events, such as abdominal pain, between groups. No one experienced antibiotic resistance.
According to AUA guidelines, antibiotic prophylaxis may be considered at the time of catheter removal, but the recommendation was based on low-quality evidence with a high risk of bias. These new trial findings bolster the recommendation. Antibiotic resistance is still a concern, however. Further research is needed to determine which subgroups would benefit from the practice.
Schwarztuch Gildor O, Buchler A, Fleischer Y, et al. Antibiotic prophylaxis at the time of catheter removal reduces hospitalization due to UTI: A prospective randomized study. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Presentation MP34-17.