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August 7, 2013
DynaMed EBM Journal Volume 8, Issue 32
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Credits
Physicians: .25 AMA PRA Category ICreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: August 7, 2013
Expiration Date: August 7, 2014
Estimated Completion Time: 15 minutes
There is no fee for this activity.
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.
Program Overview
Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA
Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA
Disclosures
Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.
Accreditation Statements
ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.
Program ID: 1304158N
Last week 503 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 179 articles were added to DynaMed content.
Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.
Antibiotic Prophylaxis Might Reduce Symptomatic UTI After Removal of Urinary Catheters in Some Post-Surgical Patients, But Evidence Insufficient to Support Routine Use
Reference: BMJ 2013 Jun 11;346:f3147, (level 2 [mid-level] evidence)
Urinary tract infections (UTIs) are among the most common hospital-acquired infections, and a large proportion of which are associated with urinary catheters. Currently, the Infectious Disease Society of America (IDSA) recommends against prophylaxis at the time of catheter removal due to concern about selecting for antimicrobial resistance (Clin Infect Dis. 2010 Mar 1;50(5):625-63). A recent systematic review of 6 randomized trials and 1 prospective cohort study compared the efficacy of antibiotic prophylaxis to placebo or no treatment for prevention of symptomatic UTI following short-term urinary catheterization (duration ≤ 14 days) in 1,520 predominantly post-surgical patients.
Antibiotics used included ciprofloxacin ranging from single dose to 3 days of therapy (in 3 trials and cohort study), trimethoprim-sulfamethoxazole ranging from single dose to 10 days of therapy (in 2 trials) and nitrofurantoin (2 doses in 1 trial). Median duration of catheterization ranged from 1.9 to 11 days in prophylaxis groups and from 1.8 to 33 days in control groups. Follow-up ranged from 4 days to 6 weeks. In analysis of all studies, antibiotic prophylaxis was associated with reduced risk of symptomatic UTIs (risk ratio 0.45, 95% CI 0.28-0.72), with a number needed to treat (NNT) of 14-34, assuming a 10.5% rate of UTIs in controls. Only 2 of the 7 trials included medical patients and the total number of medical patients included in the meta-analysis was only 76 (5%). Sub-analyses of the 5 studies of only surgical patients found similar relative risks as the entire analysis, but there was no sub-analysis that included only medical patients.
Although this meta-analysis demonstrated a significant decrease in symptomatic UTI, there are a number of concerns that limit the generalizability of the findings. There was significant heterogeneity of the patient populations (some trials restricted to genito-urinary surgery patients and others excluding them), duration of catheter use, duration of follow-up, and selection of antibiotic. Present recommendations to reduce catheter-associated urinary tract infections focus on appropriate catheter use, insertion technique and early removal. Such measures were not clearly implemented in all trials, which dated back to 1984. Finally, it is not clear that treating everyone to prevent a UTI is a superior strategy to treating the much smaller number of patients who actually get a UTI. Additional studies are needed to identify which specific populations might benefit from routine prophylaxis.
For more information, see the Catheter-associated urinary tract infection (CAUTI) topic in DynaMed.
Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.
Call for Peer Reviews
We are currently seeking reviewers for:
Catheter-associated urinary tract infection (CAUTI)
Coccidioidomycosis
Learn more about DynaMed Contribution Opportunities
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DynaMed is Hiring! We are looking for talented medical writers and editors to join our ever expanding team. Click here to learn what opportunities are available.
