Prophylaxis for Urinary Catheter Placement in Orthopaedic (Including Spinal) Patients

• Prophylactic antimicrobials should not be given routinely to orthopaedic (including spinal) patients with implanted metalware for urinary catheter placement or removal.
• In this setting, the risks of prophylaxis (e.g. development of resistant strains, adverse effects) outweigh any possible benefits.
• Antimicrobial prophylaxis is not indicated solely on the basis of orthopaedic pins, plates, screws, or other hardware.
• For catheter insertion, antimicrobial prophylaxis may be considered for patients with prosthetic joint replacement who have either a previous prosthetic joint infection or a condition that predisposes the patient to infection (See "Increased Risk of Haematogenous Total Joint Infection" box below). There is little evidence to support this approach, but it may reduce haematogenous seeding of bacteria onto prosthetic joints.
• For catheter removal, antimicrobial prophylaxis is not routinely recommended.

  Increased Risk of Haematogenous Total Joint Infection
  Patients who are within 2 years of joint replacement surgery (including joint replacements from this admission)
  Patients with prosthetic joint replacements and with: diabetes haemophilia HIV infection immunosuppression, including drug- or radiation-induced	inflammatory arthropathies, e.g. rheumatoid arthritis malignancy malnourishment previous prosthetic joint infection

Antimicrobial regimen

• When indicated, recommended antimicrobial choices are gentamicin IV or ciprofloxacin PO. If recent microbiology results suggest bacteriuria, tailor antimicrobial choice to susceptibilities.
• Gentamicin (narrower spectrum) should be used in preference to ciprofloxacin, where able.
• Use an antimicrobial other than gentamicin, if gentamicin has been given in the previous 24 hours.
• Follow usual practice (i.e. contraindications/precautions) for both agents.

First-Line

gentamicin HMLSchedNZFPMLnoids Gentamicin F: n/a Half life: 3 hours Elimination: renal fe: 0.9 Additional points: TDM.

160 mg (approximately 2 mg/kg) IV, via direct IV injection* of gentamicin 80 mg/2 mL given as undiluted solution (4 mL) or diluted with 20 mL of sodium chloride 0.9%, over 3 to 5 minutes immediately before catheter insertion.

• *Direct IV is not appropriate for larger doses, or for patients vulnerable to neuromuscular blockade due to tetraplegia, etc.

Second-Line

If gentamicin is unable to be given:

ciprofloxacin HMLSchedNZFPMLnoids Ciprofloxacin F: 0.7 Half life: 4 hours Elimination: renal fe: 0.5 Additional points: Inhibits CYP1A2 and 3A. Antacids, milk, and enteral feeds ↓ absorption.

PO 500 mg, approximately one hour before catheter insertion

• Inhibits CYP1A2 (strong) and 3A.
• Subject to OAT and OATP (transporter) inhibition.

Topic Code: 311906

must be prescribed or recommended by a consultant.