Jakob Stensballe, PhD; Michael Tvede, MD; Dagnia Looms, PhD; Freddy Knudsen Lippert, MD; Benny Dahl, DMSc; Else Tønnesen, DMSc; Lars Simon Rasmussen, PhD
Stensballe J, Tvede M, Looms D, Lippert FK, Dahl B, Tønnesen E, et al. Infection Risk with Nitrofurazone-Impregnated Urinary Catheters in Trauma Patients: A Randomized Trial. Ann Intern Med. 2007;147:285-293. doi: 10.7326/0003-4819-147-5-200709040-00002
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Published: Ann Intern Med. 2007;147(5):285-293.
Urinary tract infection is one of the most common nosocomial infections in hospitalized patients. It is predominantly associated with indwelling urinary catheters.
To determine whether nitrofurazone-impregnated urinary catheters reduce the incidence of catheter-associated bacteriuria and funguria (CABF).
Randomized, double-blind, controlled trial.
Copenhagen Trauma Center, Copenhagen, Denmark.
212 consecutive adult trauma patients admitted between July 2003 and August 2005. Eligible patients needed a urinary catheter on arrival and were excluded if they were HIV positive, were pregnant, had a primary burn injury, or were receiving steroid treatment or if informed consent was unattainable.
Nitrofurazone-impregnated or standard silicone catheter throughout the duration of catheterization.
Catheter-associated bacteriuria and funguria, defined as at least 103 colony-forming units/mL, was assessed daily until removal of the catheter, with a prespecified minimum of 24-hour follow-up for the primary analysis. The microbiologist was blinded to study group assignment.
1190 urine cultures were obtained over 1001 catheter-days. Catheter-associated bacteriuria and funguria occurred less frequently in the nitrofurazone catheter group than in the silicone catheter group (7 of 77 [9.1%] vs. 19 of 77 [24.7%]; incidence per 1000 catheter-days, 13.8 vs. 38.6; adjusted risk, 0.31 [95% CI, 0.14 to 0.70]; P= 0.005). Onset of CABF was delayed in the nitrofurazone group (P= 0.01), and nitrofurazone catheters led to fewer instances of new or changed antimicrobial therapy (adjusted risk, 0.27 [CI, 0.10 to 0.69]; P = 0.006).
The clinical significance of asymptomatic bacteriuria and funguria is unclear. Data were missing in 27% of patients, and the magnitude of effect of the nitrofurazone catheters varied by assumptions about outcomes in patients who did not complete 24-hour follow-up.
Nitrofurazone-impregnated urinary catheters reduced the incidence of CABF in adult trauma patients, reducing the need to change or prescribe new antimicrobial therapy.
ClinicalTrials.gov registration number: NCT00192985.
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Emergency Medicine, Infectious Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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