Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection

Purpose: We determined whether routine replacement of a chronic indwelling catheter before instituting antimicrobial therapy leads to an improved bact eriological or clinical outcome when treating symptomatic urinary tract inf ection in elderly nursing home residents. Materials and Methods: We performed a prospective randomized open clinical trial at 2 long-term care facilities. Patients were randomized to indwellin g catheter replacement before initiating antimicrobial therapy or no replac ement. Urine and blood cultures were done before antimicrobial therapy bega n. Clinical and microbiological outcomes were assessed after 3 days of ther apy, and 7 and 28 days after therapy was complete. Results: Enrolled in our study were 21 male and 33 female nursing home resi dents with a mean age of 72.6 years, a chronic indwelling catheter and a cl inical diagnosis of urinary tract infection. A total of 27 cases were rando mized to either catheter replacement and no replacement before antimicrobia l therapy. Polymicrobial bacteriuria significantly decreased 3 days after t herapy was initiated, and 7 and 28 days after it was discontinued in 24 ver sus 8 (p = 0.002), 18 versus 9 (p = 0.01) and 13 versus 5 (p = 0.02) patien ts with and without catheter replacement, respectively. Catheter replacemen t was also associated with a shorter time to afebrile status, improved clin ical status 72 hours after the initiation of therapy in 25 versus 11 patien ts (p <0.001) and a lower rate of symptomatic clinical relapse 28 days afte r therapy in 3 versus 11 (p = 0.015). Conclusions: Clinical and bacteriological outcomes are improved when long-t erm indwelling catheters are replaced before initiating antimicrobial thera py for symptomatic urinary tract infection.