A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in catheterized ICU patients

• Published in: Intensive care medicine Vol. 33; no. 4; pp. 726 - 729
• Main Authors: LEONE, Marc, PERRIN, Anne-Sophie, GRANIER, Isabelle, VISINTINI, Pierre, BLASCO, Valery, ANTONINI, Francois, ALBANESE, Jacques, MARTIN, Claude
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-04-2007; Berlin Springer Nature B.V
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Asymptomatic; Bacteriuria - drug therapy; Bacteriuria - etiology; Biological and medical sciences; Blood; Body temperature; Catheters; Catheters, Indwelling - adverse effects; Clinical trials; Emergency and intensive care: techniques, logistics; Female; Hospital costs; Hospital Mortality; Humans; Intensive care; Intensive care medicine; Intensive Care Units; Intubation; Length of Stay; Leukocytes; Male; Medical sciences; Middle Aged; Mortality; Nosocomial infections; Patients; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Pharmacology. Drug treatments; Sepsis; Urinary Catheterization - adverse effects; Urine; Ventilators; Human; Antibiotic; Intensive care; Bacteriuria; Antibiotics; Catheter; Urinary catheter; Asymptomatic; Resuscitation; Intensive care unit
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-007-0534-1

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.