Arthroplasty Patients with Urethral Catheters – role of antibiotics for prophylaxis and treatment

 Prophylactic antibiotics should not be given routinely to arthroplasty patients in the post-operative period for urethral catheter insertion or removal. If the patient is known to have had bacteriuria detected on pre-operative screening, or a post-operative urine sample demonstrates bacteriuria, then a dose of prophylactic antibiotics can be prescribed for either insertion or removal of the urinary catheter. The dose of Gentamicin given for surgical prophylaxis (2mg/kg) should cover any catheter removal / insertion in the first 24 hrs post-op. Where “catheter” prophylaxis is warranted gentamicin 2mg/kg iv or im can be used for this purpose.

 

Background and rationale:

In those patients who do need catheters, early catheter removal is crucial. The longer a catheter stays in, the higher the percentage that become colonised with bacteria.

The impact of giving prophylactic antibiotics for catheter removal in preventing arthroplasty infections is negligible. It is a potential source of harm to the patient (side effects, risk of allergy etc) and to the whole patient population through selective pressure promoting antibiotic resistance.

 

Catheter colonisation (which is asymptomatic) does not need treating with antibiotics – the treatment for it is catheter-removal.

Catheter-associated UTI (CAUTI)- For those small proportion of patients whose catheter colonisation becomes symptomatic UTI (with fever / sepsis with no other source, loin pain or supra-pubic pain), then antibiotic treatment and catheter removal is required. A urine sample should be sent for culture to confirm the diagnosis and ensure that the correct antibiotic is used for treatment of the CAUTI. For those with clinical catheter-associated UTI who are systemically unwell (bacteraemic), blood cultures should be taken, urine sent for culture, antibiotics started and catheter removed. Antibiotics would need adjusting as per culture and sensitivity results.

Any patient with an arthroplasty (regardless of the presence or absence of a urinary catheter) should have symptomatic UTIs promptly investigated and treated so as to minimise the risk of their joint replacement becoming infected by spread of infection haematogenously from a UTI.

 Last reviewed: 16.4.14

 For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)