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

Purpose 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. Methods 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. Results 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. Conclusion 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.