Prophylactic ciprofloxacin for catheter-associated urinary-tract infection

• Published in: The Lancet (British edition) Vol. 339; no. 8799; pp. 946 - 951
• Main Authors: Verbrugh, H.A., Verkooyen Bsc, R.P., van der Wall, E., Hustinx, W.N.M., Oostinga, J., Mintjes-De Groot, J., van Dijk, A.
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 18.04.1992; Lancet; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotics; Bacteria; Bacteriuria; Biological and medical sciences; Ciprofloxacin - therapeutic use; Drugs; Female; Health care; Humans; Infections; Kidneys; Male; Medical instruments; Medical research; Medical sciences; Middle Aged; Morbidity; Nephrology. Urinary tract diseases; Prevention; Prophylaxis; Prospective Studies; Urinary Catheterization - adverse effects; Urinary Tract Infections - etiology; Urinary Tract Infections - microbiology; Urinary Tract Infections - prevention & control; Human; Infection; Prevention; Catheter; Antibiotic; Urinary system disease
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(92)91529-H

Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n=59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% Cl] 4·7 [3·0-7·4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4·0 [2·1-7·3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4·0 [1·6-10·2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Entercoccus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage.