Catheter-Associated Urinary Infections and Consequences of Using Coated versus Non-Coated Urethral Catheters—Outcomes of a Systematic Review and Meta-Analysis of Randomized Trials

Abstract

Coated urethral catheters were introduced in clinical practice to reduce the risk of catheter-acquired urinary tract infection (CAUTI). We aimed to systematically review the incidence of CAUTI and adverse effects in randomized clinical trials of patients requiring indwelling bladder catheterization by comparing coated vs. non-coated catheters. This review was performed according to the 2020 PRISMA framework. The incidence of CAUTI and catheter-related adverse events was evaluated using the Cochran–Mantel–Haenszel method with a random-effects model and reported as the risk ratio (RR), 95% CI, and p-values. Significance was set at p <0.05 and a 95% CI. Twelve studies including 36,783 patients were included for meta-analysis. There was no significant difference in the CAUTI rate between coated and non-coated catheters (RR 0.87 95% CI 0.75–1.00, p = 0.06). Subgroup analysis demonstrated that the risk of CAUTI was significantly lower in the coated group compared with the non-coated group among patients requiring long-term catheterization (>14 days) (RR 0.82 95% CI 0.68–0.99, p = 0.04). There was no difference between the two groups in the incidence of the need for catheter exchange or the incidence of lower urinary tract symptoms after catheter removal. The benefit of coated catheters in reducing CAUTI risk among patients requiring long-term catheterization should be balanced against the increased direct costs to health care systems when compared to non-coated catheters.

Facile Modification of Medical-Grade Silicone for Antimicrobial Effectiveness and Biocompatibility: A Potential Therapeutic Strategy against Bacterial Biofilms

“…Overall, there was no significant difference in the CAUTI rate between silver-coated and noncoated catheters. However, the CAUTI risk was lower in the coated group among patients requiring catheterization for longer than 14 days . A coating comprised a palladium, gold, and silver alloy layer and a hydrogel outer layer significantly decreases the incidence of CAUTI .…”

“…However, the CAUTI risk was lower in the coated group among patients requiring catheterization for longer than 14 days. 69 A coating comprised a palladium, gold, and silver alloy layer and a hydrogel outer layer significantly decreases the incidence of CAUTI. 70 An interesting study reported leaching of metals into urine was minimal or undetectable.…”

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

“…These outcomes can be justified by several factors. First, the removal of debris enhances intraoperative visibility, mitigating the "snow-globe effect" and facilitating the identification of fragments hidden beneath it [32]. Moreover, this accessory obviates the need for fragment extraction, a time-consuming process impractical for fragments smaller than 2 mm [33].…”

Tackling catheter‐associated urinary tract infections with next‐generation antimicrobial technologies

“…Meta‐analysis of coated versus non‐coated catheters has shown no significant differences in the incidence of CAUTI between the two categories. Still, they have highlighted the importance of outweighing the direct cost of new technologies with the potential benefit to reduce CAUTI mostly for long‐term catheterization 178 . The question remains whether it is the lack of antimicrobial technologies or the effect of the conditioning film that is limiting the ability of these technologies to adequately yield antimicrobial efficacy when compared to uncoated catheters.…”