Abstract
ObjectiveTo evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization.MethodsAn electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included.ResultsA total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44–0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41–0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26–0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high.ConclusionsOur review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.
Highlights
Urinary tract infections (UTIs) are amongst the most common nosocomial infections with indwelling catheters contributing to an estimated 80% of these disorders [1,2]
Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters
Metaanalysis indicated that silver alloy-coated catheters (RR 0.63, 95%confidence intervals (CI) 0.44–0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41–0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria
Summary
Urinary tract infections (UTIs) are amongst the most common nosocomial infections with indwelling catheters contributing to an estimated 80% of these disorders [1,2]. Catheter-associated UTIs (CAUTIs) can lead to significant morbidity with prolonged hospital stays and escalation in treatment costs in both high-income and low-income countries. Umscheid et al in a review have demonstrated that approximately 65–70% of CAUTIs may be preventable with current infection-control strategies. In recent times, nursing personnel are being increasingly involved in the prevention of hospital-acquired infections. A number of nurse-led protocols, with greater participation of nurses in monitoring and timely removal of urinary catheters, have been reported [4,5]. Nurses are involved in daily catheter care and in the selection of appropriate catheters to reduce the incidence of CAUTIs [6]. Catheters have been coated with silver alloy, noble metal alloy, chlorhexidine and nitrofurazone with the sole objective of reducing the risk of CAUTIs [7,8]
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