A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in catheterized ICU patients
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To determine the effect on the occurrence of urosepsis of a treatment with a short course of antibiotics and indwelling urethral catheter replacement in clinically asymptomatic intensive care unit (ICU) patients with a positive urine culture occurring at least 48 h after catheterization.
A prospective randomized clinical trial was conducted in the medico-surgical ICU of a tertiary care centre. Sixty patients hospitalized in the ICU with an indwelling urethral catheter for longer than 48 h developing an asymptomatic positive urine culture were randomized to receive either a 3-day course of antibiotics associated with the replacement of the indwelling urethral catheter 4 h after first antibiotic administration or no antibiotics, no catheter replacement (standard of care).
Three patients in each group developed urosepsis (P = 0.1). There were no significant differences in duration of mechanical ventilation between the study group and the standard of care group (9 [4–20] days vs 5 [2–15] days, P = 0.2), in duration of urinary catheterization (22 [11–40] days vs 18 [14–33] days, P = 0.8), or in length of ICU stay (28 [13–46] vs 19 [15–34], P = 0.6). The recurrence of positive urine culture at days 7 and 15 was not affected by the randomization (P = 0.1). The profile of bacterial resistance was similar in the two groups.
Treating a positive urine culture in an asymptomatic patient with an indwelling urethral catheter does not reduce the occurrence of urosepsis in the medico-surgical ICU.
KeywordsBacteriuria Intensive care unit Urinary catheter Antibiotics
- 2.Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM, Infectious Diseases Society of America, American Society of Nephrology, American Geriatric Society (2005) Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 40:643–654PubMedCrossRefGoogle Scholar