The Effect of an Indwelling Catheter on the Bacteriology of the Male Urethra and Bladder
Authors: R. Shackman, D. Messent
Journal: BMJ (1954)

SULPHONAMIDES AND URINARY INFECTIONSBDI&PRT;oRNAL 1009 is clear that the large majority in both groups became in- fected; no significance can be ascribed to the slightly better results in the test group.From the point of view of postoperative treatment, patients with no indwelling catheter did a little better than those so treated, but it should be pointed out that six of these patients were not catheterized, and of these five were free from infection.Of the remaining 11 who were repeatedly catheterized, only one remained free.Effect of Prophylactic Sulphonamide on Type of Infection Table IV shows the organisms found in post-operative specimens of urine from the two groups of patients.It demonstrates that, although sulphonamides may prevent infection TABLE IV.-Organismns Fouind in Post-operativ e Specimens of Urinie Test Group Control Group (Sulphonamide (No Given) Sulphonamide) * Coliform bacilli 6 22 * Str.faecalis ..36 12 Coliform bacilli + Sir.faecalis 2 2 Other organisms 7 3 Total .. 51 39 * Figures for coliform bacilli and Str.faecalis include cases with one of these organisms together with another, such as Staph.pyogenes.with coliform bacilli, it is at the expense of infections due to Str. faecalis, as infections with this organism are much more likely to occur in patients given prophylactic sulphon- amides.No evidence was obtained that the patient's clinical course was altered.Of the patients given sulphonamides 29% developed a post-operative temperature of 100°F.(37.8°C.) or more: in the control group a similar tempera- ture was recorded for 31 %. DiscussionTables I andII show that the two groups of patients in this trial are not exactly comparable, the most important variation being in the number of patients in the two wards.This led to differences in post-operative management and possibly in nursing technique, but does not alter the con- clusion that urinary infection followed operation with regu- larity whatever regime was used.In the circumstances de- scribed here, prophylactic treatment with sulphonamides has failed to prevent urinary infections after vaginal operations.No support was obtained for the view that post-operative urinary infections are common in gynaecological patients because patients are frequently infected before operation.Pre-Aperative infection was found in only 6 out of the 113 patients from whom specimens were obtained.The use of an indwelling catheter for several days, or repeated catheterization, necessitated by mechanical factors, presumably accounts for the high rate of infection.Summary A clinical trial is described in which 60 patients under- going vaginal operations, who were given 1 g. of " sul- phatriad" three times a day for the first seven post- operative days, were compared with 42 controls who had no prophylactic treatment.In both groups the urine of a large majority of the patients became infected.Str. faecalis infections were relatively more frequent, and coliform bacilli less frequent in the sulphatriad group than in the controls.Our thanks are due to Mr. John Beattie, Mr. Donald Fraser, and Mr. John Howkins, whose patients were the subject of the investigation, and to the two ward sisters