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How Long Should Catheter-Acquired Urinary Tract Infection in Women Be Treated?: A Randomized Controlled Study

Godfrey K. M. Harding, MD; Lindsay E. Nicolle, MD; Allan R. Ronald, MD; Jutta K. Preiksaitis, MD; Kevin R. Forward, MD; Donald E. Low, MD; and Mary Cheang, MMath
[+] Article, Author, and Disclosure Information

Grant Support: By grant #6607-1351-54 from the National Health Research and Development Program (NHRDP), Health and Welfare Canada.

Requests for Reprints: Godfrey K. M. Harding, MD, Section of Infectious Diseases, St. Boniface General Hospital, Room A1105-409 Tache Avenue, Winnipeg, Manitoba, Canada R2H 2A6.

Current Author Addresses: Dr. Harding: Section of Infectious Diseases, St. Boniface General Hospital, Room A1105-409 Tache Avenue, Winnipeg, Manitoba, Canada R2H 2A6.

Dr. Nicolle: Infection Control Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada R3A 1R9.

Dr. Ronald: Department of Microbiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada R3K OR1.

Dr. Preiksaitis: Section of Infectious Diseases, 2E411 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada M5G 1X8.

Dr. Forward: Department of Microbiology, Victoria General Hospital, MacKenzie Building, Room 315B, 5788 University Avenue, Halifax, Nova Scotia, Canada B3H 1V8.

Dr. Low: Department of Microbiology, Mt. Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5.

Ms. Cheang: Statistical Programming, University of Manitoba, 753 McDermot Avenue, Winnipeg, Manitoba, Canada R3E OW3.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(9):713-719. doi:10.7326/0003-4819-114-9-713
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Objective: To determine the optimal management of catheter-acquired bacteriuria after short-term catheter use in women.

Patients: Asymptomatic patients (119) with catheter-acquired bacteriuria were randomly assigned to receive no therapy, a single dose (320-1600 mg) of therapy with trimethoprim-sulfamethoxazole, or 10 days (160-800 mg twice daily) of therapy. Thirty-two patients with lower tract symptoms alone received a single dose or 10 days of therapy, and 10 patients with upper tract symptoms or signs received 10 days of therapy.

Main Results: The mean and median durations of catheter use were 6 and 4 days, respectively. Bacteriuria resolved within 14 days without therapy in 15 of 42 (36%; 95% CI, 21% to 51%) asymptomatic patients. Seven of the remaining patients developed symptoms. Single-dose therapy resolved infection in 30 of 37 patients (81%; CI, 68% to 94%); 10 days of therapy resolved infection in 26 of 33 (79%; CI, 65% to 93%). For patients with lower tract symptoms alone, resolution rates with single-dose therapy or 10 days of therapy were similar (11 of 14 [79%] and 13 of 16 [81%], respectively). Ten days of therapy resolved infection in 6 of 9 (67%) patients with upper tract symptoms. Infection was resolved more often in women who were ≤ 65 years than in older women (62 of 70 [89%] versus 24 of 39 [62%]; P < 0.001). Bacteriuria resolved spontaneously more frequently in younger (14 of 19 [74%] compared with 1 of 23 older women [4%]; P < 0.001). Single-dose therapy resolved infection in 31 of 33 (94%) patients who were ≤ 65 years.

Conclusions: Asymptomatic bacteriuria after short-term catheter use frequently becomes symptomatic and should be treated. For asymptomatic patients and patients with lower tract symptoms alone, single-dose therapy was as effective as 10 days of therapy; it was very effective in women who were ≤ 65 years. Bacteriuria resolved spontaneously within 14 days after catheter removal more commonly in women who were ≤ 65 years and both types of therapy were less effective in older women.





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