Abstract
Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No: CD004013. DOI: 10.1002/14651858.CD004013.pub3. Copyright O 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This article is reproduced with the kind permission of the authors and the publisher. 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- term use as defined by the trialists (for example 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 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 1 week the results were not statistically significant. One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03- 1.63). Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection. Individual trials were too small to show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. Conclusions: The results suggest that the use of silver alloy indwelling catheters for catheterizing hospitalized adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters. Catheters impregnated with antibiotics are also beneficial in reducing bacteriuria in hospitalized adults catheterized for Neurourol. Urodynam. 27:738-746, 2008. a2008 Wiley-Liss, Inc. Key words: UTI; urethral, catheter; short-term DOI: 10.4038/sljog.v31i2.1756 Sri Lanka Journal of Obstetrics and Gynaecology 2009; 31 : 110-121
Highlights
Urinary tract infection (UTI) is the most common hospital acquired infection
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)
Antibiotic impregnated catheters were compared to standard catheters and found to lower the rate of asymptomatic bacteriuria in the antibiotic group at
Summary
Urinary tract infection (UTI) is the most common hospital acquired infection. A major associated cause is indwelling urinary catheters[1,2,3,4] These infections can be serious and lead to significant morbidity and increase in length of hospital stay. In the United States catheter-associated urinary tract infections make up 40% of all hospital-acquired infections with the proportion of these connected or contributing to mortality assessed as approximately 3%4. The risk of developing bacteriuria from a catheter increases by between 3% and 6% per day that a catheter is in situ This result in approximately 50% of hospitalized patients catheterized for longer than 7–10 days contracting an infection[4]. Factors that increase the risk of infection include female gender, older age and co-morbidities.[4]
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