Journal-Based CME Article| Volume 95, ISSUE 2, P290-296, February 2014

Short Versus Long Course of Antibiotics for Catheter-Associated Urinary Tract Infections in Patients With Spinal Cord Injury: A Randomized Controlled Noninferiority Trial

Published:September 13, 2013DOI:



      To assess the applicability of a short-course regimen of antibiotics for managing catheter-associated urinary tract infection (CA-UTI) in patients with spinal cord injury (SCI).


      Randomized, controlled, noninferiority trial.


      Medical center.


      Patients with SCI who had CA-UTI (N=61).


      Patients were randomized to receive either a 5-day regimen of antibiotics after catheter exchange (experimental group) or a 10-day regimen of antibiotics with catheter retention (control group). Noninferiority was prespecified with a margin of 10%.

      Main Outcome Measure

      Clinical cure at the end of therapy.


      Of the 61 patients enrolled in this study, 6 patients were excluded because of bacteremia or absence of urinary symptoms. All patients (100%) achieved clinical cure at the end of therapy. The rates of microbiologic response were 82.1% in the experimental group and 88.9% in the control group (upper boundary 95% confidence interval (CI) for difference, 26%). The rates of resolution of pyuria were 89.3% in the experimental group and 88.9% in the control group (upper boundary 95% CI for difference, 16%). Patients in the experimental group had higher rates of CA-UTI recurrence than the control group. The rates of new CA-UTI, diarrhea, and Clostridium difficile colitis were similar in the 2 treatment arms.


      The primary endpoint of the study was met, indicating that the 5-day regimen with catheter exchange was noninferior to the 10-day regimen with catheter retention on the basis of clinical cure. Criteria for noninferiority on the basis of microbiologic response and resolution of pyuria were not met.


      List of abbreviations:

      AE (adverse event), CA-UTI (catheter-associated urinary tract infection), CI (confidence interval), EOT (end of therapy), MEDVAMC (Michael E. DeBakey Veterans Affairs Medical Center), SCI (spinal cord injury), UTI (urinary tract infection)
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