Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infections: a prospective randomized trial

Ann Surg. 2009 Apr;249(4):573-5. doi: 10.1097/SLA.0b013e31819a0315.


Objective: To assess whether antibiotic prophylaxis at urinary catheter removal reduces the rate of urinary tract infections.

Summary of background data: Urinary tract infections are among the most common nosocomial infections. Antibiotic prophylaxis at urinary catheter removal is used as a measure to prevent them, albeit without supporting evidence.

Methods: A prospective randomized study enrolled 239 patients undergoing elective abdominal surgery, who were randomized either for receiving 3 doses of trimethoprim-sulfamethoxazole at urinary catheter removal, or not. Urinary tract infections were diagnosed according to Center of Disease Control definitions. Urinary cultures were obtained before and 3 days after catheter removal. Subjective symptoms were assessed by an independent study-blind urologist.

Results: Patients who received antibiotic prophylaxis showed significantly fewer urinary tract infections (5/103, 4.9%) than those without prophylaxis (22/102, 21.6%), P < 0.001. The absolute risk reduction for the occurrence of a urinary tract infection was 16.7%; the relative risk reduction was 77.5%, and the number needed to treat was 6. Patients with antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal (17/103, 16.5%) than those without (42/102, 41.2%), P < 0.001.

Conclusions: Antibiotic prophylaxis with trimethoprim-sulfamethoxazole on urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients undergoing abdominal surgery with perioperative transurethral urinary catheters.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Antibiotic Prophylaxis*
  • Catheter-Related Infections / prevention & control*
  • Ciprofloxacin / administration & dosage*
  • Confidence Intervals
  • Device Removal
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Preoperative Care
  • Probability
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage*
  • Urinary Catheterization / methods
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / prevention & control*


  • Ciprofloxacin
  • Trimethoprim, Sulfamethoxazole Drug Combination