Impact of antibiotic prophylaxis on catheter-associated urinary tract infections during atrial fibrillation ablation

  • David E. Lewandowski
  • David Pierce
  • Anne Barnett
  • Emmanuel Sampene
  • Nasia Safdar
  • Michael E. Field
  • Jennifer M. Wright



Urinary catheter placement is common during atrial fibrillation (AF) ablation when performed under general anesthesia. Whether patients undergoing AF ablation would benefit from prophylactic antibiotics is unknown.


Patients undergoing AF ablation in a single center from December 2011 until June 2016 were included. All patients received urinary catheters and general anesthesia. After June 2014, patients received antibiotic prophylaxis with a single dose of oral nitrofurantoin and a catheter insertion checklist performed prior to urinary catheter placement. The intervention group (group B) was compared to the pre-intervention group (group A) for development of the primary outcome. A multivariable logistic regression was performed to determine if any of the covariates were associated with catheter-associated urinary tract infection (CAUTI) development.


There were 452 patients who underwent AF ablation during the analysis period (212 in group A and 240 in group B). The average patient age was 60 years (range 23–85) and 70% of the patients were male. Utilizing an intention to treat approach, there was a significantly lower incidence of CAUTI in the intervention group compared to controls (4.7 vs. 0.83%; OR 0.18, p = 0.029). There were no significant differences between the groups with respect to urinary tract infection risk factors or catheter duration.


An intervention consisting of a single dose of nitrofurantoin in addition to performance of a catheter insertion checklist prior to urinary catheter insertion decreased CAUTI by 80% in patients undergoing AF ablation. Such interventions may be beneficial to reduce CAUTI in this group of patients.


Atrial fibrillation Catheter ablation Urinary catheter-associated urinary tract infection Antibiotic prophylaxis Quality improvement 



All authors contributed to the development of the final draft of this manuscript and approved its submission.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Centers for Disease Control and Prevention. 2014 National and State Healthcare-Associated Infections Progress Report. Published March, 2016. Available at
  2. 2.
    Meddings J, Rogers MA, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010;51(5):550–60.CrossRefPubMedGoogle Scholar
  3. 3.
    Voss AB. Incidence and duration of urinary catheters in hospitalized older adults: before and after implementing a geriatric protocol. J Gerontol Nurs. 2009;35(6):35–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Rothfeld AF, Stickley A. A program to limit urinary catheter use at an acute care hospital. Am J Infect Control. 2010;38(7):568–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Van Hees BC, Vijverberg PL, Hoorntje LE, et al. Single-dose antibiotic prophylaxis for urinary catheter removal does not reduce the risk of urinary tract infection in surgical patients: a randomized double-blind placebo-controlled trial. Clin Microbiol Infect. 2011;17:1091–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Pfefferkorn U, Sanlav L, Moldenhauer J, Peterli R, von Flüe M, Ackermann C. Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infections: a prospective randomized trial. Ann Surg. 2009;249(4):573–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Marschall J, Carpenter CR, Fowler S, Trautner BW, for the CDC Prevention Epicenters Program. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis. BMJ. 2013;346:f3147.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antibiotic prophylaxis. J Urol. 2008;179:1379–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Di Biase L, Conti S, Mohanty P, et al. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: Results from a randomized study. Heart Rhythm. 2011;8(3):368–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Gould CV, Umscheid CA, Agarwal RK et al. Guideline for prevention of catheter associated urinary tract infections 2009. The Centers for Disease Control and Prevention (CDC, 2009). Retrieved from
  12. 12.
    Willson M, Wilde M, Webb M, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Wisconsin Hospitals and ClinicsMadisonUSA

Personalised recommendations