What’s New in the Patient Safety World
January 2013
Silver-Coated Urinary Catheters Don’t Reduce CAUTI’s
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:
- May 8, 2007 Tip of the Week “Doctor, when do I get this red rubber hose removed?”
- January 8, 2008 Tip of the Week “Urinary Catheter-Associated Infections”
- April 2008 What’s New in the
Patient Safety World column “More
on Nosocomial UTI’s”
- June 24, 2008 Tip of the Week “Urinary Catheter-Related UTI’s: Bladder Bundles”
- April 21, 2009 Tip of the Week “Still Futzing with Foleys?”
- June 9, 2009 Tip of the Week “CDC Update to the Guideline for Prevention of CAUTI”
- March 2010 “IDSA
CAUTI Guidelines”
- February 2011 What’s New in the Patient Safety World column “Catheters Not Needed in C-Sections?”
- January 2012 “CAUTI’s
Still Get No Respect”
- May 2012 “Foley
Catheter Hazards”
- November 2012 “CAUTI
Conundrum”
- December 18, 2012 “Unintended
Consequences of the CAUTI Measure?”
References:
Liedberg H,
Lundeberg T. Silver Alloy Coated Catheters Reduce Catheter-associated
Bacteriuria. British Journal of Urology 1990; 65(4): 379–381
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.1990.tb14760.x/abstract
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
http://www.amjmed.com/article/S0002-9343%2898%2900240-X/abstract
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
http://archinte.jamanetwork.com/article.aspx?articleid=485555
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
http://europepmc.org/abstract/MED/15573050/reload=0;jsessionid=iw2CF0dN1E2U8qDb2wdU.12
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
http://www.journals.uchicago.edu/doi/pdf/10.1086/650482
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
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961380-4/abstract#
Print “PDF
version”
http://www.patientsafetysolutions.com/