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Rate of UTIs in pts using special catheters = rate using standard catheters

Clinical Question:
Do special antimicrobial urinary catheters prevent urinary tract infections in hospitalized patients?

Bottom Line:
In this study, the rate of urinary tract infections (UTIs) in hospitalized patients using silver alloy catheters or antimicrobial-impregnated catheters was the same as the rate in those using standard catheters. The antimicrobial-impregnated catheters were associated with more participant-reported discomfort during use and at removal. This study does not address whether the catheters were needed in the first place. (LOE = 1b-)

Reference:
Pickard R, Lam T, MacLennan G, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancet 2012;380(9857):1927-1935.  [PMID:23134837]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Government

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
In this multicenter British study, hospitalized patients undergoing short-term urethral catheterization (anticipated for less than 2 weeks) were randomized to receive standard catheters (n = 2144), silver-alloy catheters (n = 2097), or antimicrobial-impregnated (nitrofural) catheters (n = 2153). Although the "need" for urethral catheterizations is often overstated, the authors don't describe how the initial decision came about in this study. They excluded patients with UTI at time of catheter placement, those who'd had a urologic procedure during the preceding 7 days, and those with allergy to the catheter materials. While the allocation was concealed, the participants and researchers were aware of what kind of catheter was used. For the 6 weeks of the study duration, the researchers evaluated each patient for the development of catheter-associated UTI, defined as having symptoms of UTI plus receiving an antibiotic prescription regardless of whether the UTI was microbiologically confirmed (a secondary outcome). The rate of catheter-associated UTI was 12.6% in the group receiving standard catheters compared with 12.5% in those receiving silver-alloy catheters and 10.6% in the antimicrobial-impregnated catheter group. Although the differences were not statistically significant between the 3 groups, the rate of UTIs increased the longer the catheters remained in place. The nitrofural catheters were associated with more participant-reported discomfort during use and at removal.

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