Wazait Hassan D, Patel Hitenddra R, van der Meulen Jan H P, Ghei Maneesh, Al-Buheissi Salah, Kelsey Michael, Miller Ronald A, Emberton Mark
Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
BJU Int. 2004 Nov;94(7):1048-50. doi: 10.1111/j.1464-410X.2004.05102.x.
To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI).
Patients across specialities with a urethral catheter in situ for >/= 48 h and </= 7 days were recruited at the time of catheter removal. Patients were excluded if they had had recent genitourinary surgery or were on antibiotics. Eligible patients were randomly assigned to a 48-h course of either ciprofloxacin or placebo tablets starting 2 h before catheter removal. A catheter specimen of urine was obtained before the start of the trial medication. The follow-up was at 7 and 14 days after catheter removal, with a questionnaire for UTI symptoms, and a mid-stream urine sample was taken.
Forty-eight patients were recruited and had a complete follow-up (25 received ciprofloxacin and 23 placebo). Of the ciprofloxacin group, four patients (16%) had a UTI at the follow-up after catheter removal, and two were symptomatic. The UTI in two patients (including one of those symptomatic) was newly developed after catheter removal; the other two UTIs were a result of failure to resolve a catheter-associated UTI. All these UTIs in the ciprofloxacin group were resistant to ciprofloxacin. Of the placebo group, three patients (13%) had a UTI at the follow-up after removal, and one patient was symptomatic. The UTI, newly developed after catheter removal, was resistant to ciprofloxacin. The other two patients were asymptomatic; their UTIs were a result of failure to resolve a catheter-associated UTI, and one was resistant to ciprofloxacin.
The risk of UTI (both symptomatic and asymptomatic) after removing a urethral catheter is real, even in absence of catheter-associated UTI before removal. UTIs occurring after removing a short-term urinary catheter had a high rate of resistance to ciprofloxacin. There was no detectable significant benefit in using prophylactic ciprofloxacin to reduce the UTI rate after catheter removal.
评估在拔除短期尿道导管时开始使用短疗程抗生素是否能降低随后发生尿路感染（UTI）的发生率。
在拔除导管时招募留置尿道导管≥48小时且≤7天的各专科患者。近期有泌尿生殖系统手术或正在使用抗生素的患者被排除。符合条件的患者被随机分配，在拔除导管前2小时开始服用48小时疗程的环丙沙星或安慰剂片剂。在试验用药开始前获取导管尿标本。在拔除导管后7天和14天进行随访，采用问卷调查UTI症状，并采集中段尿样本。
招募了48例患者并进行了完整随访（25例接受环丙沙星，23例接受安慰剂）。在环丙沙星组中，4例患者（16%）在拔除导管后的随访中发生UTI，其中2例有症状。2例患者（包括1例有症状者）的UTI是在拔除导管后新发生的；另外2例UTI是导管相关UTI未缓解所致。环丙沙星组所有这些UTI对环丙沙星耐药。在安慰剂组中，3例患者（13%）在拔除后随访中发生UTI，1例有症状。拔除导管后新发生的UTI对环丙沙星耐药。另外2例患者无症状；他们的UTI是导管相关UTI未缓解所致，1例对环丙沙星耐药。
拔除尿道导管后发生UTI（有症状和无症状）的风险是真实存在的，即使在拔除前没有导管相关UTI。拔除短期导尿管后发生的UTI对环丙沙星耐药率高。使用预防性环丙沙星降低拔除导管后UTI发生率未发现明显益处。
