Should patients with long-term urinary catheters receive antibiotic prophylaxis at the time of catheter change?
The NICE infection prevention guidelines for primary and community care (NICE, 2003) recommend that:
‘Antibiotic prophylaxis when changing catheters should only be used for patients with a history of catheter-associated urinary tract infection following catheter change, or for patients who have a heart valve lesion, septal defect, patent ductus arteriosus or prosthetic valve defect.’
The recommendation to reserve antibiotic prophylaxis for these two groups only was based on a prospective study of 120 catheter changes without chemoprophylaxis that found a zero incidence of clinical complications, despite a 5.5% incidence of subclinical bacteraemia detected by blood culture (Bregenzer et al, 1997).
In addition, a systematic review (Saint and Lipsky 1999) noted a general agreement among experts that the routine use of prophylactic antibiotics should be avoided on grounds of cost, potential adverse effects and the danger of encouraging antibiotic resistance. It found evidence of antibiotics being useful for preventing urinary tract infections in patients catheterised for 3–14 days and especially valuable in patients undergoing transurethral resection of the prostate and renal transplantation.
In 2008, the NICE guidance on prophylaxis against endocarditis (NICE, 2008) recommended that antibiotics were not required for people undergoing non-dental procedures at the following sites:
- Upper and lower gastrointestinal tract;
- Genitourinary tract; this includes urological,
- Gynaecological and obstetric procedures, and childbirth;
- Upper and lower respiratory tract – this includes ear, nose and throat procedures and bronchoscopy.
In view of this, antibiotic prophylaxis is no longer recommended for changing urinary catheters in patients at risk of infective endocarditis. However the recommendation still stands for those who have a history of catheter-associated urinary tract infection after having a catheter changed.
Carol Pellowe, EdD, MA Ed, BA, RN, RNT, is deputy director, Richard Wells Research Centre, Joanna Briggs Institute Collaborating Centre, Faculty of Health and Human Sciences, Thames Valley University, Brentford.
Bregenzer, T. et al (1997) Low risk of bacteraemia during catheter replacement in patients with long-term urinary catheters. Archives of Medicine; 157: 5, 521–525.
Saint, S., Lipsky, B.A. (1999) Preventing catheter-related bacteriuria. Should we? Can we? How? Archives ofInternal Medicine; 159: 800–808.