A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in catheterized ICU patients

Objective: To determine the effect on the occurrence of urosepsis of a treatment with a short course of antibiotics and indwelling urethral catheter replacement in clinically asymptomatic intensive care unit (ICU) patients with a positive urine culture occurring at least 48 h after catheterization. Methods: A prospective randomized clinical trial was conducted in the medico-surgical ICU of a tertiary care centre. Sixty patients hospitalized in the ICU with an indwelling urethral catheter for longer than 48 h developing an asymptomatic positive urine culture were randomized to receive either a 3-day course of antibiotics associated with the replacement of the indwelling urethral catheter 4 h after first antibiotic administration or no antibiotics, no catheter replacement (standard of care). Results: Three patients in each group developed urosepsis (P = 0.1). There were no significant differences in duration of mechanical ventilation between the study group and the standard of care group (9 [4-20] days vs 5 [2-15] days, P = 0.2), in duration of urinary catheterization (22 [11-40] days vs 18 [14-33] days, P = 0.8), or in length of ICU stay (28 [13-46] vs 19 [15-34], P = 0.6). The recurrence of positive urine culture at days 7 and 15 was not affected by the randomization (P = 0.1). The profile of bacterial resistance was similar in the two groups. Conclusions: Treating a positive urine culture in an asymptomatic patient with an indwelling urethral catheter does not reduce the occurrence of urosepsis in the medico-surgical ICU.