Types of urethral catheters for management of short-term voiding problems in hospitalized adults: a short version Cochrane Review

Abstract

Background: Urinary tract infection (UTI) is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialized urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and cost. Objectives:The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterization. Methods:We searched the Specialized Trials Register of the Cochrane Incontinence Group (searched September 11, 2007). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials. All randomized and quasi-randomized trials comparing types of indwelling urinary catheters for short-term catheterization in hospitalized adults. Shortterm catheterization was defined as up to and including 14 days, or other temporary short- E-mail: k.schumm@abdn.ac.uk term use as defined by the trialists (for example <21 days with data time points at 7-day intervals). Data were extracted by one reviewer and independently verified by a second reviewer for both the original review and for the update. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Where data in trials were not fully reported, clarification was sought directly from the trialists (secondary sources were used to confirm results of one trial).Results: Twentythree trials met the inclusion criteria involving 5,236 hospitalized adults in 22 parallel group trials and 27,878 adults in one large cluster-randomized cross-over trial. The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterized hospitalized adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68-1.15) and these catheters are no longer available. Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.54, 95% CI 0.43-0.67) in hospitalized adults catheterized for <1 week. At >1 week of catheterization the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.64, 95% CI 0.51-0.80). The randomized cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3% and 35.5%. Antibiotic impregnated catheters were compared to standard catheters and found to lower the rate of asymptomatic bacteriuria in the antibiotic group at...

A prospective interventional study to examine the effect of a silver alloy and hydrogel--coated catheter on the incidence of catheter-associated urinary tract infection

“…The noble metal alloy indwelling catheter has been shown in multiple large clinical trials and smaller case studies to reduce the incidence of CA-UTI, when compared with conventional catheters. [9][10][11][12][13][14][15] These studies have examined endpoints such as bacteriuria and symptomatic CA-UTI, or surveillance-defined UTI. 8,16,17 In a study by Pickard et al, 17 noble metal alloy catheters were found to be ineffective in reducing the incidence of symptomatic surveillance-defined UTI when used in short-term (mean, 2 days) surgical patients and they did not support the routine use of these catheters in this patient group.…”

A New Intervention For Preventing Urinary Tract Infections: Uroshield

“…Kateter ilişkili infeksiyonların tümünde temel mekanizma kateter lümeni üzerinde mikroorganizmaların biyofilm tabakası oluşturmasıdır (7)(8)(9) . Üriner kateter takılan hastaların % 20-30'unda ilk 7 gün içerisinde asemptomatik bakteriüri gelişmektedir.…”

Catheter blockage factors in patients cared for in their own home requiring long‐term urinary catheterisation

“…Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria, as reported in a literature review. However, these studies involved <1 week of catheterization (Schumm and Lam, ), so results are inapplicable to long‐term urinary catheterization. Thus, no conclusion has been reached.…”