TY - JOUR
T1 - Prophylactic ciprofloxacin for catheter-associated urinary-tract infection
AU - Verbrugh, H. A.
AU - Verkooyen Bsc, R. P.
AU - van der Wall, E.
AU - Hustinx, W. N.M.
AU - Oostinga, J.
AU - Mintjes-De Groot, J.
AU - Verbrugh, H. A.
AU - van Dijk, A.
N1 - Funding Information:
for prophylaxis because it is easy to administer, is well absorbed orally, is effective in the treatment of uncomplicated and complicated urinary-tract infection,23 has been used prophylactically patients granulocytopenia with success,24 and in because it has withfew side-effects.25 Ciprofloxacin prophylaxis caused a complete but transient disappearance of enterobacteriaceae species and glucose-non-fermenting gram-negative bacilli from the faecal flora, confirming previous findings.24.26 Eradication of the aerobic gram-negative gut flora may be an important determinant of ciprofloxacin’s efficacy in preventing nosocomial infection since most urinary-tract infections are thought to be due to bacteria from the gut. At six-weeks’ follow-up, bacteriuria and pyuria were less common in patients that had received ciprofloxacin than in placebo patients, indicating that the protective effect of ciprofloxacin may last for weeks after its discontinuation. Since dysuria was also prevented this long-lasting effect seems clinically relevant. Development of resistance to ciprofloxacin among initially sensitive, clinically important bacteria is uncommon. Bacterial resistance to fluoroquinolones is mediated by chromosomal mutations altering DNA gyrase, which confer resistance to quinolones alone, or by changes in the permeability of the cell wall, which may prevent penetration of other antibiotics and thus confer cross-resistance 27 Ciprofloxacin-resistant strains of enterobacteriaceae or glucose-non-fermenting gram- negative species were not observed in this study. Yet, ciprofloxacin-resistant aerobic gram-positive bacteria, mostly a-haemolytic streptococci and S epidermidis, were cultured from the faecal and urine samples of pateints given ciprofloxacin; ciprofloxacin-resistant S aureus was not found. Thus, ciprofloxacin prophylaxis altered the aerobic microflora of patients in favour of those species that inherently less sensitive or completely resistant to fluoroquinolones, but did not lead to the emergence of resistant strains of species that are normally sensitive to fluoroquinolones. Surveillance of hospital-acquired infections showed that wards that took part in the study and other wards in our hospitals did not experience an increase in the frequency, or changes in the spectrum, of antibiotic- resistant organisms causing nosocomial infections. We conclude that ciprofloxacin can be safely prescribed postoperatively to selected patients receiving bladder drainage; once daily doses of 250 mg are probably sufficient. Although we have not observed emergence of ciprofloxacin-resistant strains of aerobic gram-negative bacteria, we must caution against overinterpretation of our results. The use of other classes of antimicrobials (eg, &bgr;-lactams or sulphonamides) in this setting has been associated with failure of prophylaxis and emergence of resistance. 28 We believe that ciprofloxacin prophylaxis should be reserved for well-defined groups of patients that will have bladder drainage for more than 2 days but less than two or three weeks. Active surveillance of hospital-acquired infections, including monitoring for resistant nosocomial pathogens, is essential. We thank Dr R. Andriesse, Dr M. A. V. M. Kroeks, Dr P. Leguit, Dr W. Derks, and Dr J. W. R. Nortier for their clinical support, and the nursing staff of the participating wards for their cooperation in this study. This study was supported by the Diakonessen Hospital Research Germany.Foundation, and clinical research grant from Bayer AG, Leverkussen,
PY - 1992/4/18
Y1 - 1992/4/18
N2 - Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n=59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% Cl] 4·7 [3·0-7·4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4·0 [2·1-7·3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4·0 [1·6-10·2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Entercoccus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage.
AB - Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n=59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% Cl] 4·7 [3·0-7·4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4·0 [2·1-7·3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4·0 [1·6-10·2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Entercoccus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage.
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U2 - 10.1016/0140-6736(92)91529-H
DO - 10.1016/0140-6736(92)91529-H
M3 - Article
C2 - 1348797
AN - SCOPUS:0026577089
SN - 0140-6736
VL - 339
SP - 946
EP - 951
JO - The Lancet
JF - The Lancet
IS - 8799
ER -