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

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.