Antibiotics Prophylaxis For Catheter-Associated Urinary Tract Infections:Meta-Analysis

Objective:To systematically review the effectiveness and safety of antibiotics prophylaxis for catheter-associated urinary tract infections (CAUTI).Methods:Databases including Pubmed, Cochrane library, Wiley Online Library, China Knowledge Resource Integrated Database (CNKI) and WANFANG databases were searched from1980to March2014to collect the randomized controlled trials(RCTs) on antibiotics prophylaxis for CAUTI. According to inclusion criteria(hospitalized patients with systemic antibiotic prophylaxis before application of indwelling catheters, during application of indwelling catheters or after removal of catheters)and exclusion criteria, data of the included studies were extracted, and the methodological quality was evaluated. Then meta-analysis was performed using RevMan5.2and the R software package R2WinBUGS. the evidence qualities and recommendation levels were determined according to the GRADE System.Results:A total of13studies were included. The results of meta-analysis showed that when we compare the antibiotic group and the control group, the antibiotic group showed reduced the incidence of bacteriuria with removal of the catheter within48h (OR0.14, 95%CI[0.05,0.43], P=0.0005), the incidence of bacteriuria after antibiotic prophylaxis ending within7d(OR0.21,95%CI [0.10,0.45], P<0.0001), the incidence of bacteriuria after single-dose intervention(OR0.4,95%CI[0.28,0.58], P<0.00001), the incidence of pyuria after antibiotic prophylaxis ending(OR0.22,95%CI[0.13,0.38], P<0.00001)and the incidence of positive urine culture after antibiotic prophylaxis ending(OR0.36,95%CI[0.20,0.66], P=0.0009). There are no significant difference in the incidence of bacteriuria among the patients using levofloxacin, trimethoprim-sulfamethoxazole and ciprofloxacin after antibiotic prophylaxis was comleted.Conclusion:Currently, the limited evidence shows that when surgery patients (such as diabetics or immune-compromised patients, and so on) without urinary tract infection before surgery have short-time indwelling catheters after perioperative stage, they use single-dose antibiotics before or after removal of indwelling catheters within48h that can effectively reduce secondary urinary tract infection.The incidence of its side effects (such as adverse reactions, bacterial resistance, and so on)did not increase. This conclusion still needs to be further proved by higher-quality and large-scale RCTs.