Effect of silver oxide/trichloroisocyanuric acid antimicrobial urinary drainage system on catheter-associated bacteriuria

We assessed the efficacy of silver oxide coating of the indwelling urethral catheter and catheter adapter, and instillation of trichloroisocyanuric acid into the urinary drainage bag in the prevention of catheter-associated bacteriuria in a prospective and randomized study of 74 patients. Bacteriuria was documented in 29 of the 74 patients (39 per cent). There was a significant difference between the attack rates, with 11 of 41 patients (27 per cent) in the test group and 18 of 33 (55 per cent) in the control group having bacteriuria (p equals 0.02) after a median time to bacteriuria of 36 and 8 days, respectively (p equals 0.01). Urethral meatal colonization was implicated as the source of bladder bacteriuria in 12 of 18 patients (67 per cent) in the control group and 5 of 11 (45 per cent) in the test group. Trichloroisocyanuric acid significantly reduced drainage bag contamination but bag contamination with the same microorganism responsible for bacteriuria preceded infection in only 2 of the 29 patients (7 per cent), 1 in each group. Patients who received systemic antimicrobial agents acquired bacteriuria less frequently than those who did not. The apparent protective effect of systemic antimicrobials was strongest during the first 4 days of catheterization. The data indicate that episodes of bacteriuria arising from the urethral meatus are common among catheterized patients and that the antimicrobial catheter is effective in reducing the incidence of catheter-associated bacteriuria.     

Efficacy of prophylactic antimicrobial regimens in preventing infectious complications after transrectal biopsy of the prostate

In a prospective study on 81 patients undergoing transrectal needle biopsy of the prostate, the efficacy of prophylaxis in preventing postbiopsy infectious complications was determined. The patients were divided randomly into four groups, and a comparison of the rate of postbiopsy complications in each group was made. In 11 and 17% of the patients in Group A (n=18) who received povidone-iodine enema alone, bacteriuria and bacteraemia, respectively, occurred. When parenteral piperacillin alone in Group B (n=22) was administered, the rates of the same complications were 9 and 14%, respectively, while both rates were as low as 4% in Group C (n=25) when piperacillin in combination with povidone-iodine enema was given. On the other hand, in 31 and 37.5% of the patients in Group D (n=16), who served as controls, bacteriuria and bacteraemia developed. The study has thus shown that parenteral piperacillin in combination with povidone-iodine enema significantly reduces the incidence of infectious complications associated with transrectal prostatic biopsy.     

Use of antimicrobials for patients undergoing prostatectomy

Our suggestions for the use of antimicrobials in patients undergoing prostatectomy are summarized in Table 2. The use of antimicrobial prophylaxis perioperatively for patients without bacteriuria remains controversial. Some authors recommend and others do not recommend antimicrobial prophylaxis. We do not recommend perioperative prophylaxis for low-risk patients without previous urinary tract infections or an indwelling urethral catheter. We do recommend that patients with risk factors that increase the rate or consequence of urinary tract infection, those with previous urinary tract infections, or those with indwelling urethral catheters, even though the urine shows no growth, receive perioperative antimicrobial prophylaxis. Antimicrobial therapy is mandatory for patients with preoperative bacteriuria. The drug must be selected according to the susceptibility of the pathogen, and the duration of treatment must be guided by the severity of the infection. At the time of catheter removal, antimicrobial prophylaxis is probably beneficial, and antimicrobial therapy is essential if bacteriuria is present prior to catheter removal. All patients must have cultures after catheter removal and antimicrobial therapy if a urinary tract infection is identified.     

长效抗菌材料“洁悠神”对留置导尿管伴随性尿路感染预防的研究

目的:应用具有物理抗菌功能的分子膜性结构材料喷涂在在导尿管表面和尿道口,观察其能否降低留置导尿管伴随性尿路感染(CAUTI)的发生。方法:60例经尿道前列腺电切术(TURP)术后留置导尿管的男性患者,年龄68~79岁。随机分为对照组30例和用药组30例。对照组,按常规行尿道口护理,2次/d;用药组,按常规行尿道口护理后,加用“洁悠神”喷洒于导尿管与尿道口,2次/d。观察两组患者置留导尿管后第3、5、7 d膀胱内尿液标本的细菌培养结果并比较。结果:用药组置管期间尿培养尿路感染病例数显著低于对照组(P<0.01)。结论:对留置导尿管的患者使用长效抗菌材料"洁悠神”进行导尿管表面和尿道口喷洒,可形成一层物理抗菌分子膜,阻止细菌生物膜的形成,有效降低CAUTI的发生。     

Antimicrobial prophylaxis in transurethral resection of the prostate. With special reference to preoperatively sterile urine.

The literature on antimicrobial prophylaxis in connection with transurethral resection of the prostate (TURP) is reviewed, and it is concluded that there is no proof of clinically significant beneficial effect of prophylaxis when the urine is sterile preoperatively. Prophylaxis is indicated when bacteriuria or an indwelling urethral catheter is present at the time of operation. Other possible risk factors, such as diabetes mellitus, neurogenic bladder dysfunction, immunosuppression, earlier coronary bypass operation and the presence of prosthetic devices, need further investigation.     

Catheter-associated bacteriuria

Catheter-associated urinary tract infections are the most common nosocomial infection and a frequent cause of significant morbidity, sepsis, and death. The pathogenesis is multifaceted. Most frequently, bacteria from the urethral meatus ascend to the bladder between the mucosal and catheter surfaces. Alternatively, bacteria may ascend within the drainage system following contamination of the drainage bag or disruption of the catheter tubing junction. The incidence of infection is approximately 5 to 7 per cent for each day of catheterization and closely linked to unalterable host factors such as age, female sex, and debilitating disease. Efforts to reduce the incidence of infection must begin with reduction of the frequency and duration of catheterization. Aseptic insertion of the catheter and careful maintenance of the drainage system are mandatory to prevent incidental bacterial contamination. Prophylactic, systemic, or topical antimicrobial agents and modifications of the catheter drainage system that are designed to reduce contamination are expensive and have not been shown to be efficacious for the majority of patients. Furthermore, antimicrobial prophylaxis frequently leads to outgrowth of resistant bacterial strains that are difficult to eradicate. However, antimicrobial prophylaxis warrants consideration for high-risk patients who are catheterized for a short time. If bacteriuria occurs prior to removal of the catheter, the patient should be treated with appropriate antimicrobial therapy. Urinalysis or urine cultures should be obtained following removal of the catheter to assure sterility of the urinary tract. If these guidelines are followed, the incidence and sequelae of catheter-associated urinary tract infections can be reduced.     

CAGS and ACS Evidence Based Reviews In Surgery. 37: Is there a role for prophylactic antibiotics in the prevention of urinary tract infections following Foley catheter removal in patients having abdominal surgery?

Question: Does the use of antibiotic prophylaxis at urinary catheter removal reduce the rate of urinary tract infection? Design: Randomized controlled trial. Setting: Single centre in Basel, Switzerland. Patients: A total of 239 patients between January 2005 and September 2007 were randomly assigned into 2 groups by an online randomization generator. Intervention: Patients undergoing elective abdominal surgery with planned perioperative urethral catheterization were assigned at admission to receive either 960 mg of trimethoprim-sulfamethoxazole orally the night before and twice on the day of catheter removal or no antibiotic prophylaxis. Urinary cultures were obtained before and 3 days after catheter removal. Main outcome measures: Occurrence of symptomatic urinary tract infection (based on the Centers for Disease Control and Prevention definitions) after catheter removal. Results: Patients who received antibiotic pro-phylaxis experienced significantly fewer urinary tract infections than those who did not (5 of 103 [4.9%] v. 22 of 102 [21.6%], p < 0.001; number needed to treat 6). Patients who received antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal than those who did not (17 of 103 [16.5%] v. 42 of 102 [41.2%], p < 0.001). Conclusion: Antibiotic prophylaxis with trimethoprim-sulfamethoxazole at the time of urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients who undergo abdominal surgery and perioperatively receive transurethral urinary catheters.     

Prospective, randomized, multicentric, open, comparative study on the efficacy of a prophylactic single dose of 500 mg levofloxacin versus 1920 mg trimethoprim/sulfamethoxazole versus a control group in patients undergoing TUR of the prostate

OBJECTIVES: Transurethral resection of the prostate (TUR-P) is one of the most frequent urological procedures. The efficacy of a prophylactic single dose of levofloxacin vs. trimethoprim/sulfamethoxazole (TMP/SMZ) vs. a control group, receiving no antibiotic prophylaxis, in patients undergoing TUR-P was investigated in a multicentre study. The aims were to assess the rate of bacteriuria (cfu> or =10(4)/ml) 5 to 7 days, and 3 to 5 weeks after TUR-P, as well as postoperative complications. METHODS: The study was prospective, randomized, multicentric, open and comparative. Patients without bacteriuria (cfu<10(4)/ml) scheduled for TUR-P and not having received antibiotics prior within four days were enclosed. Patients received an oral single dose prophylaxis with either 500 mg levofloxacin, or 320/1600 mg TMP/SMZ, or no prophylaxis according to a 2:2:1 randomization. Clinical examination of the patients and urine culture were performed prior to, 5 to 7 days and 3 to 5 weeks after TUR-P. RESULTS: 14 urological centres throughout Germany recruited 400 patients. 376 patients were evaluable until day 5 to 7, 339 until week 3 to 5. Overall bacteriuria rate at day 5 to 7 was 22% (levofloxacin 21%; TMP/SMZ 20%; control group 30%). Bacteriuria rate at week 3 to 5 was 28% (levofloxacin 26%; TMP/SMZ 26%; control group 36%). Complication rate at week 3 to 5 was 10% (levofloxacin 8%; TMP/SMZ 10%; control group 16%). The rates of postoperative bacteriuria ranged widely between centers (0%-75%). Statistically significant (p<0.05) risk factors for bacteriuria (range) were qualification of surgeon (19%-37%), presence of a suprapubic catheter (22%-34%), disconnection of the closed drainage system (25%-52%), operating time (12%-31%) and operative centre (0%-75%). Total antibiotic consumption (for prophylaxis and treatment) in the control group was higher and more expensive than in groups with antibiotic prophylaxis (6.9 vs. 5.0 doses/patient; 24.9 vs. 19.7 /patient) (p<0.0001). Postoperative complications in patients with bacteriuria (cfu> or =10(4)/ml) were more frequent than in non bacteriuric (cfu<10(4)/ml) patients (17% vs. 8%) (p<0.01). CONCLUSIONS: It is debatable whether postoperative bacteriuria is the key parameter to define efficacy of antimicrobial prophylaxis in patients undergoing TUR-P. The rate of bacteriuria, however, correlated well with the overall rate of postoperative complications. Therefore, it seems reasonable to lower the rate of bacteriuria by prophylaxis. Since patients without antibiotic prophylaxis received at the end even more antibiotic doses than patients with prophylaxis, the overall selection pressure by antibiotic usage can obviously not be lowered by resigning prophylaxis. Therefore we conclude that at least patients at risk should receive antibiotic prophylaxis prior to TUR-P.     

Prophylactic single-dose prulifloxacin for catheter-associated urinary tract infection after tension-free vaginal tape procedure

The purpose of the study was to evaluate whether antibiotic prophylaxis with a single dose of prulifloxacin after tension-free vaginal tape (TVT) procedure decreases catheter-associated urinary tract infections (UTIs). Patients undergoing TVT procedure receiving a single dose of prulifloxacin (600 mg) 10 h before catheter removal (n = 54) were compared with historical controls who have had no treatment (n = 60). All patients had an indwelling urethral catheter in situ for 24 h. Urine specimens for culture were collected preoperatively, before Foley removal, and 7 days postoperatively in both groups. Main outcome measures were significant bacteriuria and symptomatic UTI at catheter removal and 1 week postoperatively. No patient had a positive urine culture in the prulifloxacin group compared with 14 (23.3%) in the control group at catheter removal (P = 0.0001). Ten out of 14 (71.4%) women with a positive catheter urine culture had a symptomatic UTI. One week after surgery no difference was found in the rate of significant bacteriuria between groups. Our data suggest that a prophylactic single dose of prulifloxacin could help to reduce the rate of symptomatic and asymptomatic UTIs after short-term urethral catheterization in women undergoing TVT procedure.     

Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam

OBJECTIVE: To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). PATIENTS AND METHODS: Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. RESULTS: Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects. CONCLUSIONS: This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.     

Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: a systematic review

PURPOSE: We determined whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in men undergoing transurethral resection of the prostate (TURP) who have preoperative urine with less than 100,000 bacteria per ml. MATERIALS AND METHODS: MEDLINE, EMBASE (Elsevier B.V., Amsterdam, The Netherlands) and the Cochrane Library were searched for randomized and quasi-randomized controlled trials that compared the effects of antibiotic prophylaxis with placebo or active controls for men undergoing TURP with preoperative sterile urine. Two reviewers independently extracted patient characteristic and outcomes data based on a prospectively developed protocol. RESULTS: A total of 28 trials, 10 placebo controlled and 18 no treatment controlled, involving 4,694 patients, met the inclusion criteria. The mean age of the subjects was 69 years and the majority underwent TURP for prostatic hyperplasia (85%). Antibiotic prophylaxis was significantly more effective than placebo in reducing postoperative TURP complications. The risk differences for post-TURP bacteriuria, high degree fever, bacteremia and use of additional antibiotic treatment were -0.17 (95% CI 0.20, -0.15), -0.11 (-0.15, -0.06), -0.02 (-0.04, 0.00) and -0.20 (-0.28, -0.11), respectively. The results were observed consistently across all classes of antibiotics assessed. There was no difference in the duration of postoperative catheterization or hospitalization. Adverse events were rare, generally mild, and included allergic reactions, pyrexia and abdominal complaints. CONCLUSIONS: Prophylactic antibiotics decrease the incidence of post-TURP bacteriuria, high fever, bacteremia and additional antibiotic treatment. Additional research should evaluate the optimal antibiotic regimen, and whether the cost and possibility of the development of resistant strains of organisms justify the routine use of prophylactic antibiotics.     

Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased infectious or hemorrhagic complications? A prospective randomized trial

PURPOSE: Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method. MATERIALS AND METHODS: A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy. RESULTS: The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group. CONCLUSIONS: Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.     

The efficacy of a novel antibacterial hydroxyapatite nanoparticle-coated indwelling urinary catheter in preventing biofilm formation and catheter-associated urinary tract infection in rabbits

The aim of this study was to investigate of the efficacy and reliability of a novel antimicrobial hydroxyapatite (HA) nanoparticle coating of urethral catheters, in the prophylaxis of biofilm formation and bacteriuria in rabbits. A total of 60 male rabbits were randomized to the control and study groups and each group was divided into three subgroups depending on 3, 5 and 7 days of the urethral catheterization period. The rabbits in the study group were catheterized with Ag⁺-incorporated nano-HA coated urethral catheters and those in the control group with standard silicon–latex urethral catheters. Urine and catheter surface smear samples were conducted for bacteriological analysis. Catheter cross-section samples were undergone measuring of biofilm thickness. Tissue samples of bladder and urethra were inspected for histological changes. The results indicate that at the end of 7 days of the catheterization period, the number of the rabbits with bacteriuria was significantly lower in the study group versus control group (p ^¶ = 0.020). The biofilm formation on luminal surface of the catheters was significantly thinner in the study group versus control group, at the end of 5 and 7 days of the catheterization period (0.035 and 0.035, respectively).No histological adverse change or particle penetration was detected in the urothelium. In conclusion, it was observed that Ag⁺ + HA nanoparticle coating significantly lowered the incidence of catheter-related bacteriuria and decreased biofilm formation, at the end of 7 days study period. The novel antimicrobial urethral catheter coating appeared to have a potential in the prophylaxis of catheter-induced urinary tract infections.     

Luminal nitric oxide in ileal reservoirs for continent cutaneous diversion or orthotopic bladder reconstruction

OBJECTIVES: To measure mucosal inflammation as reflected in nitric oxide (NO) production in ileal reservoirs for the storage of urine and to correlate it with the growth of bacteria as well as CRP. METHODS: Intraluminal gas NO concentrations were determined using the chemoluminescence technique in 25 patients with continent cutaneous ileal reservoirs (Kock pouch) and 12 patients with orthotopic bladders (hemi-Kock or T-pouch). NO concentrations were determined in both intestinal reservoir gas and silicon catheter balloon gas. Urinary culture and blood CRP determinations were performed. RESULTS: NO concentrations in reservoir gas were higher than in silicon catheter balloons. Bacteriuria was associated with approximately 20 times higher NO concentrations than sterile urine. NO concentrations did not differ between continent cutaneous reservoirs or orthotopic bladders when due attention was paid to variance in the rate of bacteriuria. Elevated CRP was associated with higher NO concentrations. Bacteriuria with acinetobacter, enterococci and pseudomonas appeared to cause comparatively lower NO concentrations. The inflammatory response of reservoir walls to bacteriuria did not decrease with time. CONCLUSIONS: Urine in itself causes much less intestinal wall inflammation than bacteriuria, as reflected in NO production. High CRP values are associated with high NO concentrations. The inflammatory response varies with the bacterial specimens.     

Meta分析抗生素对TURP术后感染性并发症的预防效果

目的　分析预防性抗生素能否减少术前为清洁尿、行经尿道前列腺切除术 (TURP)患者的术后感染性并发症。　方法　制定原始文献的纳入标准、排除标准及检索策略 ,在美国医学索引(MEDLINE)、荷兰医学文摘 (EMBASE)药理学分册、中国生物医学文摘 (CBMA)、及Cochrane图书馆(CL)内进行相关的随机对照试验的检索、质量评价和资料提取。应用RevMan软件进行数据处理 ;计数资料的效应尺度以相对危险度 (RR)及其 95 %可信区间 (95 %CI)表示 ;计量资料的效应尺度以加权均数差 (WMD)及其 95 %CI表示。　结果　共检索到相关随机对照试验 5 3篇 ,排除 2 6篇 ,符合纳入标准 2 7篇进入Meta分析。结果表明 :术前清洁尿的患者 ,预防性抗生素能显著降低TURP术后 1周内菌尿、术后发热、菌血症的发生率和术后需继续抗生素治疗的比率 ,RR值及其 95 %CI分别为 0 .36(0 .2 8～ 0 .4 6 )、0 .83(0 .71～ 0 .97)、0 .4 3(0 .2 2～ 0 .86 )及 0 .2 6 (0 .2 0～ 0 .33) ;但尚不能确定预防性抗生素能否缩短患者住院时间 ,其WMD及 95 %CI为 - 0 .31(- 0 .78～ 0 .35 )。　结论　术前为清洁尿的患者 ,预防性应用抗生素能减少TURP术后菌尿、发热、菌血症的发生率和术后需继续抗生素治疗的比率 ;尚不能确定能否缩短术后住院时间。     

Trimethoprim versus gentamicin for the prevention of bacteriuria following transrectal biopsy of the prostate--do patients need additional anaerobic cover?

OBJECTIVES: To study the incidence of aerobic and anaerobic bacteriuria in patients undergoing transrectal ultrasound-guided biopsies of the prostate. A comparative assessment of efficacy of trimethoprim with gentamicin for the prevention of bacteriuria following the transrectal biopsy of the prostate. To assess the need for additional prophylaxis against anaerobes for patients undergoing transrectal biopsies of the prostate gland. PATIENTS AND METHODS: In a pilot study during 1995-1997, all the patients undergoing transrectal ultrasound-guided biopsy of the prostate were randomised to receive either trimethoprim or gentamicin prophylaxis prior to the procedure. Midstream urine (MSU) samples were taken just prior to biopsy and 72 h later. A patient questionnaire to determine the symptoms of urinary tract infection (UTI) accompanied the 72-hour MSU request form. Urine samples were cultured aerobically, using a semiquantitative technique if dipstick analysis revealed the presence of blood, pus cell or nitrite. In addition to the routine aerobic culture, post-biopsy samples were also cultured for anaerobes by direct and enrichment methods. Bacteriuria was defined as a pure or mixed growth of 10(5) colony-forming units/ml. Fisher's test of exact probability was used for statistical analysis. RESULTS: 115 patients were available for final analysis. 53 had received gentamicin and 62 trimethoprim. Four patients had pre-existing bacteriuria (3.5%), 3 in the trimethoprim group and 1 in the gentamicin group. Post-operative bacteriuria developed in 5 patients given gentamicin (9.4%) and 1 given trimethoprim (1.6%). This difference was not statistically significant (p = 0.085). Post-procedure bacteriuria was asymptomatic in all but 1 case. Anaerobes were detected in only 5 MSUs (4.3%) post-biopsy. CONCLUSION: Though there was no statistical significant difference in the rates of bacteriuria following administration of trimethoprim and gentamicin, data appear to favour trimethoprim prophylaxis. Further studies are warranted. Transrectal biopsy of the prostate is associated with a low incidence of anaerobic UTI. In view of the very low incidence of anaerobic bacteriuria, routine antibacterial prophylaxis against anaerobes does not appear to be justified.     

Antibiotic prophylaxis for patients undergoing transurethral resection of the prostate

Objectives

To evaluate the prevention of urinary tract infections (UTIs) after transurethral resection of the prostate (TURP) in a prospective randomized study using a quinolone antibiotic (fleroxacin) to compare the efficacy of: (1) a single oral dose, (2) a single intravenous (IV) dose, and (3) an extended regimen consisting of an initial IV dose followed by oral therapy until removal of the urinary catheter, but for less than 6 days.

Methods

We excluded from study patients who received antimicrobial agents within 48 hours of surgery. Single-dose prophylaxis consisted of 400 mg of fleroxacin given either orally or intravenously. The extended regimen consisted of an initial 400 mg IV dose followed by 400 mg oral each day (patients older than 75 years, or with a creatinine clearance less than 40 mL/min, received 200 mg/day). UTI was defined as clinical evidence of infection plus the presence of more than 10 white blood cells (WBC)/mm³ in any urine specimen plus the presence of more than 10⁴ cfu/mL in midstream urine specimens or more than 10² cfu/mL in catheter specimens.

Results

Prior to TURP, 30% (25/84) of the patients had a urethral catheter in situ and 12% (3/25) of these patients had bacteriuria. Only 1 patient developed a UTI and that was 22 days after a TURP (intergroup comparisons, Fisher's exact test greater than 0.05). There were no instances of urosepsis.

Conclusions

A single oral dose of a fluoroquinolone agent provided optimum prophylaxis for patients undergoing TURP.     

Prophylactic efficacy of a new gentamicin-releasing urethral catheter in short-term catheterized rabbits

OBJECTIVE: To describe an indwelling urethral catheter coated with gentamicin sulphate on the inner and outer surface of the catheter, and to evaluate the efficacy and safety of this catheter in preventing catheter-associated infections in rabbits. Materials and methods Sixty rabbits were divided equally into control and experimental groups which were then subdivided equally according to the duration of catheterization (1, 3 and 5 days). Silicone-treated latex catheters were used in the control group and gentamicin-releasing catheters in the experimental group. Urine samples and surface swabs from the catheter were cultured for bacteriological assessment, and the catheter surface examined by scanning electron microscopy to structurally analyse the biofilms. RESULTS: The gentamicin-releasing catheter reduced the incidence of bacteriuria (defined as > or = 100 c.f.u./mL) after both 3 and 5 days of catheterization (eight and 10 rabbits, respectively, for the control catheter, vs two and four rabbits for the gentamicin-releasing catheter, P < 0.05). The surfaces of the gentamicin-releasing catheter were colonized less often than those of the control catheter after both 3 and 5 days (eight and 10, respectively, for the control, vs one and four for the gentamicin-releasing catheter, P < 0.05). Scanning electron microscopy showed the formation of bacterial biofilm throughout the 3-day and 5-day control catheters, but deterioration of the bacterial biofilm was visible on the surface of the gentamicin-releasing catheters. CONCLUSION: This new gentamicin-releasing catheter produced an antibacterial barrier which inhibited catheter-associated urinary tract infection with no toxicity for at least 5 days. These in vivo studies suggest that this new catheter may be useful for controlling infection, with systemic and local safety, in patients undergoing short-term indwelling urethral catheterization.     

Total joint arthroplasty and incidence of postoperative bacteriuria with an indwelling catheter or intermittent catheterization with one-dose antibiotic prophylaxis: a prospective randomized trial

This study examined the difference in postoperative bacteriuria in total joint arthroplasty after use of either an indwelling catheter or intermittent catheterization. Previous studies showed a preference for an indwelling catheter over intermittent catheterization to resolve postoperative urinary retention in total joint arthroplasty, but these studies generally used 48 hours of antibiotic prophylaxis. Increasing awareness of costs and bacterial resistance to antibiotics have prompted many centers to reduce prophylaxis to only 1 preoperative dose A prospective, randomized, controlled trial was conducted in primary total hip and primary total knee arthroplasty patients. One dose of cefazolin, 1 g, was administered intravenously immediately preoperatively. Five of 13 (38%) men in the indwelling catheter group and 0 of 14 (0%) men in the intermittent catheterization group developed postoperative bacteriuria (P =.016), and 6 of 33 (18%) women in the indwelling catheter group and 3 of 39 (8%) women in the intermittent catheterization group developed postoperative bacteriuria (not significant). A total of 11 (24%) patients in the indwelling catheter group (n = 46) and 3 (6%) patients in the intermittent catheterization group (n = 53) developed postoperative bacteriuria (P =.018). In this setting with 1-dose antibiotic prophylaxis, intermittent catheterization resulted in a lower incidence of postoperative bacteriuria compared with an indwelling catheter. For men, this difference is significant.     

Randomised clinical trial of Hydrofiber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds

This prospective, randomised clinical trial compared pain, comfort, exudate management, wound healing and safety with Hydrofiber dressing with ionic silver (Hydrofiber Ag dressing) and with povidone-iodine gauze for the treatment of open surgical and traumatic wounds. Patients were treated with Hydrofiber Ag dressing or povidone-iodine gauze for up to 2 weeks. Pain severity was measured with a 10-cm visual analogue scale (VAS). Other parameters were assessed clinically with various scales. Pain VAS scores decreased during dressing removal in both groups, and decreased while the dressing was in place in the Hydrofiber Ag dressing group (n = 35) but not in the povidone-iodine gauze group (n = 32). Pain VAS scores were similar between treatment groups. At final evaluation, Hydrofiber Ag dressing was significantly better than povidone-iodine gauze for overall ability to manage pain (P < 0.001), overall comfort (P < or = 0.001), wound trauma on dressing removal (P = 0.001), exudate handling (P < 0.001) and ease of use (P < or = 0.001). Rates of complete healing at study completion were 23% for Hydrofiber Ag dressing and 9% for povidone-iodine gauze (P = ns). No adverse events were reported with Hydrofiber Ag dressing; one subject discontinued povidone-iodine gauze due to adverse skin reaction. Hydrofiber Ag dressing supported wound healing and reduced overall pain compared with povidone-iodine gauze in the treatment of open surgical wounds requiring an antimicrobial dressing.