COCHRANE CORNER
By Robin Christian, DNP, FNP-C
Editor’s note: This is a summary of a nursing care–related systematic review from the Cochrane Library.
Do Prophylactic Antibiotics Reduce UTI Risk After Urodynamic Studies? REVIEW QUESTION
Does the administration of prophylactic antibiotics reduce the risk of urinary tract infections (UTIs) after urodynamic studies?
TYPE OF REVIEW
This is a systematic review containing nine randomized controlled trials comparing the use of prophylactic antibiotics with a placebo or no treatment in patients undergoing urodynamic testing.
RELEVANCE FOR NURSING
Urodynamic studies are used to identify problems of the lower urinary tract. However, the procedures may cause symptomatic UTIs. UTIs can cause dysuria, frequency, pain, hematuria, and fever. If these complications can be prevented with the use of prophylactic antibiotics, patient outcomes after urodynamic studies might improve. However, there are risks involved with the prophylactic use of antibiotics, including adverse effects and bacterial resistance, as well as the question of their cost-effectiveness. A careful balance must be considered when prescribing antibiotics for this purpose.
CHARACTERISTICS OF THE EVIDENCE
Nine randomized controlled trials were identified containing 973 patients between the ages of 18 and 82. The nine trials took place in seven countries. Antibiotics could be any type, dose, or route given 24 hours before or up to 72 hours after urodynamic studies. Antibiotics were given as a one-time dose in six trials and as multiple doses in three trials. Seven different antibiotics were used, but the route of administration and dose were not documented. Urodynamic studies were performed using standard techniques (not described or defined). The primary outcome was a UTI, defined as the presence of more than 100,000 bacteria per milliliter. Other outcomes included pyrexia, hematuria, dysuria, and adverse reactions to antibiotics. Outcomes were assessed at various times, and all trials were carried out in a hospital or outpatient setting. A meta-analysis was performed to help overcome the small sample size and poor quality of the trials. Five trials measured symptomatic UTIs. Patients receiving prophylactic antibiotics had fewer UTIs after 20
AJN ▼ February 2014
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Vol. 114, No. 2
urodynamic studies than patients receiving no antibiotics (20% versus 28%, respectively), however this difference did not reach statistical significance. Bacteriuria was reported in all nine trials. The risk of bacteriuria was significantly lower in participants receiving prophylactic antibiotics than in those receiving placebo. Subgroup analyses of three trials containing only men and seven trials containing only women also produced a reduction in the risk of bacteriuria in participants taking prophylactic antibiotics. Two studies indicated that when compared with no antibiotics, the administration of prophylactic antibiotics significantly reduced the risk of hematuria. There were not enough data to assess the risk of fever (two trials) or dysuria (two trials). Two trials reported adverse reactions to antibiotics, but only two of 135 participants (2%) had an adverse reaction.
BEST PRACTICE RECOMMENDATIONS
The use of prophylactic antibiotics must be weighed against the possibility of adverse effects. Prophylactic antibiotics did reduce the risk of bacteriuria after urodynamic studies in these nine trials, but there wasn’t enough evidence to suggest that they also reduced symptomatic UTIs. Prophylactic antibiotics can be used to reduce the risk of significant bacteriuria after urodynamic testing, but there is limited evidence to guide clinicians in their use.
RESEARCH RECOMMENDATIONS
The effectiveness of prophylactic antibiotics in reducing the symptoms of UTIs is unclear. There is a need for more randomized controlled trials comparing antibiotics, routes of administration, and other interventions on outcomes such as symptomatic UTIs and cost-effectiveness. ▼ Robin Christian is chair of the Department of Graduate Nursing at Alcorn State University in Natchez, MS, and a member of the Cochrane Nursing Care Field.
SOURCE DOCUMENT Foon R, et al. Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies. Cochrane Database Syst Rev 2012;10:CD008224. ajnonline.com
By Robin Christian, DNP, FNP-C
Editor’s note: This is a summary of a nursing care–related systematic review from the Cochrane Library.
Do Prophylactic Antibiotics Reduce UTI Risk After Urodynamic Studies? REVIEW QUESTION
Does the administration of prophylactic antibiotics reduce the risk of urinary tract infections (UTIs) after urodynamic studies?
TYPE OF REVIEW
This is a systematic review containing nine randomized controlled trials comparing the use of prophylactic antibiotics with a placebo or no treatment in patients undergoing urodynamic testing.
RELEVANCE FOR NURSING
Urodynamic studies are used to identify problems of the lower urinary tract. However, the procedures may cause symptomatic UTIs. UTIs can cause dysuria, frequency, pain, hematuria, and fever. If these complications can be prevented with the use of prophylactic antibiotics, patient outcomes after urodynamic studies might improve. However, there are risks involved with the prophylactic use of antibiotics, including adverse effects and bacterial resistance, as well as the question of their cost-effectiveness. A careful balance must be considered when prescribing antibiotics for this purpose.
CHARACTERISTICS OF THE EVIDENCE
Nine randomized controlled trials were identified containing 973 patients between the ages of 18 and 82. The nine trials took place in seven countries. Antibiotics could be any type, dose, or route given 24 hours before or up to 72 hours after urodynamic studies. Antibiotics were given as a one-time dose in six trials and as multiple doses in three trials. Seven different antibiotics were used, but the route of administration and dose were not documented. Urodynamic studies were performed using standard techniques (not described or defined). The primary outcome was a UTI, defined as the presence of more than 100,000 bacteria per milliliter. Other outcomes included pyrexia, hematuria, dysuria, and adverse reactions to antibiotics. Outcomes were assessed at various times, and all trials were carried out in a hospital or outpatient setting. A meta-analysis was performed to help overcome the small sample size and poor quality of the trials. Five trials measured symptomatic UTIs. Patients receiving prophylactic antibiotics had fewer UTIs after 20
AJN ▼ February 2014
▼
Vol. 114, No. 2
urodynamic studies than patients receiving no antibiotics (20% versus 28%, respectively), however this difference did not reach statistical significance. Bacteriuria was reported in all nine trials. The risk of bacteriuria was significantly lower in participants receiving prophylactic antibiotics than in those receiving placebo. Subgroup analyses of three trials containing only men and seven trials containing only women also produced a reduction in the risk of bacteriuria in participants taking prophylactic antibiotics. Two studies indicated that when compared with no antibiotics, the administration of prophylactic antibiotics significantly reduced the risk of hematuria. There were not enough data to assess the risk of fever (two trials) or dysuria (two trials). Two trials reported adverse reactions to antibiotics, but only two of 135 participants (2%) had an adverse reaction.
BEST PRACTICE RECOMMENDATIONS
The use of prophylactic antibiotics must be weighed against the possibility of adverse effects. Prophylactic antibiotics did reduce the risk of bacteriuria after urodynamic studies in these nine trials, but there wasn’t enough evidence to suggest that they also reduced symptomatic UTIs. Prophylactic antibiotics can be used to reduce the risk of significant bacteriuria after urodynamic testing, but there is limited evidence to guide clinicians in their use.
RESEARCH RECOMMENDATIONS
The effectiveness of prophylactic antibiotics in reducing the symptoms of UTIs is unclear. There is a need for more randomized controlled trials comparing antibiotics, routes of administration, and other interventions on outcomes such as symptomatic UTIs and cost-effectiveness. ▼ Robin Christian is chair of the Department of Graduate Nursing at Alcorn State University in Natchez, MS, and a member of the Cochrane Nursing Care Field.
SOURCE DOCUMENT Foon R, et al. Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies. Cochrane Database Syst Rev 2012;10:CD008224. ajnonline.com
