Antimicrobial catheters do not significantly reduce UTI risk

Silver alloy-coated antimicrobial catheters do not significantly reduce the risk for catheter-associated urinary tract infection (CAUTI) compared with standard catheters in adult hospital patients requiring short-term catheterization, show UK study results.

Similarly, reductions in CAUTI observed with nitrofural-impregnated versus standard catheters in the same study were considered clinically unimportant, leading the researchers to conclude that their findings do not support the routine use of antimicrobial-impregnated catheters.

"Overall, patients, clinicians, and health-care providers probably ought to persist with straightforward strategies to prevent CAUTI and await any adjustment of guidance on CAUTI prevention in the light of our results before making a decision," suggest Robert Pickard (Newcastle University, UK), and co-investigators.

They compared CAUTI rates among 2097 patients who were randomly assigned to receive a silver alloy catheter, 2153 who were assigned to receive a nitrofural catheter, and 2144 who received a standard polytetrafluoroethylene (PTFE)-coated latex catheter.

The researchers proposed that, in order for them to recommend a change in routine practice, the rates of CAUTI achieved with the antimicrobial catheters had to be at least 3.3% lower than those achieved with standard catheters. However, neither type of catheter reached this minimum threshold.

As reported in The Lancet, the primary outcome in the study was incidence of CAUTI, defined as the presence of participant-reported symptoms of UTI and clinician prescription of antibiotic for a UTI at any time in the 6 weeks after catheter randomization, between July 2007 and October 2010.

The researchers report CAUTI rates of 12.5% for patients with silver alloy catheters, 10.6% for patients with nitrofural catheters, and 12.6% for patients with PTFE catheters, which acted as the 'control' reference.

These figures equate to 0.1% and 2.1% reductions in CAUTI rates with silver alloy and nitrofural catheters, respectively, compared with the PTFE standard, neither of which crossed the 3.3% threshold for clinical significance.

After adjusting data for age, gender, comorbidities, indication for catheterization, and antibiotic use prior to catheterization, silver alloy catheters reduced CAUTI rates by a nonsignificant 4%, while nitrofural catheters reduced rates by a borderline-significant 19%.

Pickard and colleagues do not regard use of either catheter type as clinically beneficial. Moreover, they write, "the potential for increased discomfort [with the nitrofural type], which was reported by about one in nine participants, adds to the distress of an already intimate invasive intervention."

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