James R. Johnson, MD; Michael A. Kuskowski, PhD; Timothy J. Wilt, MD, MPH
Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect those of the U.S. Department of Veterans Affairs.
Acknowledgments: The authors thank David Nelson, who provided suggestions on the study design and analytic approach, and Dave Prentiss, who prepared the figures.
Grant Support: By the Office of Research and Development, Medical Research Service, U.S. Department of Veterans Affairs, and Rochester Medical Corp. (Stewartville, Minnesota), the manufacturer of the nitrofurazone-coated catheter.
Potential Financial Conflicts of Interest: Consultancies: J.R. Johnson (Rochester Medical Corp.); Receipt of payment for involvement in the preparation of this manuscript: J.R. Johnson (Rochester Medical Corp.).
Requests for Single Reprints: James R. Johnson, MD, Infectious Diseases (111-F), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417; e-mail, email@example.com.
Current Author Addresses: Dr. Johnson: Infectious Diseases (111-F), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
Dr. Kuskowski: Geriatric Research, Education, and Clinical Center (11-G), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
Dr. Wilt: Center for Chronic Disease Outcomes Research and Section of General Medicine (111-0), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
The efficacy of antimicrobial urinary catheters in hospitalized patients is poorly defined.
To assess currently marketed antimicrobial urinary catheters for preventing catheter-associated urinary tract infection (UTI).
Electronic databases, conference proceedings, bibliographies, trialists, and catheter manufacturers (search dates, 1966 to June 2005).
Randomized and quasi-randomized trials of nitrofurazone-coated or silver alloy–coated antimicrobial urinary catheter use for less than 30 days; no language restriction.
Study design, study sample, inclusion and exclusion criteria, allocation, blinding, UTI definition, ascertainment methods, and proportion developing symptomatic UTI (primary end point) or bacteriuria (secondary end point) were extracted by using a structured data collection instrument.
Twelve qualifying trials (13 392 total participants or catheters) were identified. They compared nitrofurazone-coated silicone (n = 3) or silver-coated latex (n = 9) catheters with silicone or latex catheters. No study addressed symptomatic UTI. All trials suggested protection against bacteriuria with test catheter use. However, effect size varied considerably and postrandomization exclusions were very common. Effect size was greatest in trials of nitrofurazone-coated catheters (all post-1995) and in pre-1995 silver alloy–coated catheter trials and was smallest in post-1995 silver alloy–coated catheter trials. Control group bacteriuria rate, control catheter type (latex vs. silicone), and patient sample (urology vs. other) also predicted effect size. Few studies addressed secondary bloodstream infection, mortality, costs, or microbial resistance. Short-term adverse effects were minimal.
The study was limited by the number, size, and quality of studies and by lack of the following: intention-to-treat analyses, data on clinical end points, and trials comparing nitrofurazone-coated with silver alloy–coated catheters.
According to fair-quality evidence, antimicrobial urinary catheters can prevent bacteriuria in hospitalized patients during short-term catheterization, depending on antimicrobial coating and several other variables. Older data probably lack current relevance. Cost implications and effect on infectious complications remain undefined.
Literature search and selection process.
Table 1. Characteristics of Randomized and Quasi-Randomized Trials of Currently Marketed Antimicrobial Urinary Catheters for Prevention of Catheter-Associated Bacteriuria or Funguria during Short-Term Bladder Drainage in Hospitalized Patients
Table 2. Summary Characteristics of 12 Randomized or Quasi-Randomized Clinical Trials of Antimicrobial Urinary Catheters
Outcomes (total and stratified) of randomized and quasi-randomized clinical trials of currently marketed antimicrobial urinary catheters.
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Johnson JR, Kuskowski MA, Wilt TJ. Systematic Review: Antimicrobial Urinary Catheters To Prevent Catheter-Associated Urinary Tract Infection in Hospitalized Patients. Ann Intern Med. 2006;144:116–126. doi: 10.7326/0003-4819-144-2-200601170-00009
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Published: Ann Intern Med. 2006;144(2):116-126.
Hospital Medicine, Hospital-Acquired Infections, Infectious Disease, Nephrology, Urinary Tract Infection.
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