Could antibiotics eliminate catheter urosepsis?
D.W. CONLEY, MD, of Whitby, ON, wonders, "In a geriatric patient with a history of urosepsis and chronic catheter drainage, is there any indication for abbreviated antibiotic therapy with monthly catheter change?"
Chronic bacteriuria will always be present with long-term catheter drainage. In fact, it's 100% positive with open drainage, and 50% positive within two weeks even with a careful closed drainage. So, if we use bacteriuria as a guide, antimicrobial therapy will always be indicated. But if we offer antibiotics, we'll ultimately have resistant organisms.
This is why long-term antimicrobial therapy is discouraged. What we do recommend are cranberry juice, fluids and short-term antibiotic therapy in the presence of fever or gross hematuria.
What's not clear is whether the discouragement of antibiotics should extend to agents like methenamine or even nitrofurantoin. YT
(see our geriatric specialistâ€™s response to this question in the geriatrics category)