For many years antibiotic-coated or silver-coated catheters have been touted as potentially reducing CAUTI’s. Such recommendations were based mostly on studies in relatively small populations or studies using methodologies other than randomized controlled trials (eg. Liedberg 1990). Saint et al. in a meta-analysis noted discrepant results among trials of silver-coated urinary catheters and noted that silver alloy catheters are significantly more effective in preventing urinary tract infections than are silver oxide catheters (Saint 1998). Karchmer et al. (Karchmer 2000) found that the risk of infection declined by 32% among patients in whom silver-coated catheters were used on the wards and that use of the more expensive silver-coated catheter appeared to offer cost savings by preventing excess hospital costs from nosocomial UTI associated with catheter use. Rupp et al. found that a silver alloy, hydrogel-coated urinary catheter was associated with a significant decline in nosocomial UTI and cost savings over the range of cost estimates (Rupp 2004).
But despite those studies, there has remained considerable controversy and doubt as to whether silver-coated (or antimicrobial-coated) catheters reduce CAUTI rates. In our March 2010 What’s New in the Patient Safety World column “IDSA CAUTI Guidelines” we discussed the Infectious Diseases Society of America guidelines on CAUTI’s “Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America” (Hooton 2010). The guidelines were developed in collaboration with multiple other specialty societies. In those guidelines they concluded that evidence was insufficient to make a recommendation as to whether silver-coated or antibiotic-coated urinary catheters were effective in reducing catheter-related bacteruria or CAUTI’s.
Now a new large randomized controlled trial hopefully puts the issue to rest (Pickard 2012). Patients requiring short-term urinary catheterization were randomly allocated 1:1:1 to receive a silver alloy-coated catheter, a nitrofural-impregnated catheter, or a PTFE-coated catheter (control group). Compared with 271 (12·6%) of 2144 participants in the control group, 263 (12·5%) of 2097 participants allocated a silver alloy catheter developed a symptomatic CAUTI by 6 weeks, as did 228 (10·6%) of 2153 participants allocated a nitrofural catheter. They concluded that silver alloy-coated catheters were not effective for reduction of incidence of symptomatic CAUTI and that the reduction in CAUTI associated with nitrofural-impregnated catheters was less than that regarded as clinically important. Routine use of antimicrobial-impregnated catheters is not supported by this trial.
Our other columns on urinary catheter-associated UTI’s:
Liedberg H, Lundeberg T. Silver Alloy Coated Catheters Reduce Catheter-associated Bacteriuria. British Journal of Urology 1990; 65(4): 379–381
Saint S, Elmore JG, Sullivan SD, Emerson SS, Koepsell TD. The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis. Am J Med 1998; 105(3): 236-41
Karchmer TB, Giannetta ET, Muto CA, et al. A Randomized Crossover Study of Silver-Coated Urinary Catheters in Hospitalized Patients. Arch Intern Med. 2000; 160(21): 3294-3298
Rupp ME, Fitzgerald T, Marion N, et al. Effect of silver-coated urinary catheters: efficacy, cost-effectiveness, and antimicrobial resistance. American Journal of Infection Control 2004; 32(8): 445-450
Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases 2010; 50: 625-663
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
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