Document Detail


Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial.
MedLine Citation:
PMID:  23134837     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is a major preventable cause of harm for patients in hospital. We aimed to establish whether short-term routine use of antimicrobial catheters reduced risk of CAUTI compared with standard polytetrafluoroethylene (PTFE) catheterisation.
METHODS: In our parallel, three group, multicentre, randomised controlled superiority trial, we enrolled adults (aged ≥16 years) requiring short-term (≤14 days) catheterisation at 24 hospitals in the UK. Participants were randomly allocated 1:1:1 with a remote computer allocation to receive a silver alloy-coated catheter, a nitrofural-impregnated catheter, or a PTFE-coated catheter (control group). Patients undergoing unplanned catheterisation were also included and consent for participation was obtained retrospectively. Participants and trial staff were unmasked to treatment assignment. Data were collected by trial staff and by patient-reported questionnaires for 6 weeks after randomisation. The primary outcome was incidence of symptomatic urinary tract infection for which an antibiotic was prescribed by 6 weeks. We postulated that a 3·3% absolute reduction in CAUTI would represent sufficient benefit to recommend routine use of antimicrobial catheters. This study is registered, number ISRCTN75198618.
FINDINGS: 708 (10%) of 7102 randomly allocated participants were not catheterised, did not confirm consent, or withdrew, and were not included in the primary analyses. Compared with 271 (12·6%) of 2144 participants in the control group, 263 (12·5%) of 2097 participants allocated a silver alloy catheter had the primary outcome (difference -0·1% [95% CI -2·4 to 2·2]), as did 228 (10·6%) of 2153 participants allocated a nitrofural catheter (-2·1% [-4·2 to 0·1]). Rates of catheter-related discomfort were higher in the nitrofural group than they were in the other groups.
INTERPRETATION: Silver alloy-coated catheters were not effective for reduction of incidence of symptomatic CAUTI. The reduction we noted 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.
FUNDING: UK National Institute for Health Research Health Technology Assessment Programme.
Authors:
Robert Pickard; Thomas Lam; Graeme MacLennan; Kath Starr; Mary Kilonzo; Gladys McPherson; Katie Gillies; Alison McDonald; Katherine Walton; Brian Buckley; Cathryn Glazener; Charles Boachie; Jennifer Burr; John Norrie; Luke Vale; Adrian Grant; James N'Dow
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-11-05
Journal Detail:
Title:  Lancet     Volume:  380     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-03     Completed Date:  2012-12-17     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1927-35     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
Affiliation:
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. robert.pickard@newcastle.ac.uk
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN75198618
Export Citation:
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anti-Bacterial Agents / administration & dosage*
Catheter-Related Infections / prevention & control*
Female
Humans
Male
Middle Aged
Nitrofurazone / administration & dosage*
Urinary Catheterization / adverse effects*
Urinary Tract Infections / prevention & control*
Young Adult
Grant Support
ID/Acronym/Agency:
//Chief Scientist Office
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 59-87-0/Nitrofurazone
Comments/Corrections
Comment In:
J Urol. 2013 May;189(5):1735   [PMID:  23594635 ]
Lancet. 2012 Dec 1;380(9857):1891-2   [PMID:  23134836 ]
Lancet. 2013 May 4;381(9877):1536   [PMID:  23642694 ]
Lancet. 2013 May 4;381(9877):1535-6   [PMID:  23642691 ]
Lancet. 2013 May 4;381(9877):1535   [PMID:  23642692 ]

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