Types of urinary catheters for management of short term voiding problems in hospitalised adults

Schumm K, Lam TBL

Published Online:

November 10, 2010

Urinary catheters are small tubes inserted through the urethra (outlet for urine). They are often used for a short time after major surgery or to monitor urine output in hospitalised patients. About half of all hospitalised adults who have urinary catheters in for longer than a week will get a urinary tract infection. The review of trials found that silver alloy (antiseptic) coated or nitrofurazone-impregnated (antibiotic) urinary catheters might reduce the presence of bacteria in the urine of hospitalised adults with temporary urinary catheters, and siliconised catheters might cause the least adverse effects in men, but the evidence was weak. Larger, more scientifically rigorous, trials are needed to determine if catheters impregnated with antibiotics or antiseptics can reduce urinary tract infection.

Abstract (click to read)

Background:

Urinary tract infection (UTI) is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialised urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and cost.

Objectives:

The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterisation.

Search strategy:

We searched the Cochrane Incontinence Group Specialised Register of trials (searched 24 May 2010). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials.

Selection criteria:

All randomised and quasi randomised trials comparing types of indwelling urinary catheters for short-term catheterisation in hospitalised adults. Short-term catheterisation was defined as up to and including fourteen days, or other temporary short-term use as defined by the trialists (for example less than 21 days with data time points at seven day intervals).

Data collection and analysis:

Data were extracted by one reviewer and independently verified by a second reviewer. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Where data in trials were not fully reported, clarification was sought directly from the trialists (secondary sources were used to confirm results of one trial).

Main results:

Twenty three trials met the inclusion criteria involving 5236 hospitalised adults in 22 parallel group trials and 27,878 adults in one large cluster-randomised cross-over trial.

The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterised hospitalised adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68 to 1.15) and these catheters are no longer available. Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.54, 95% CI 0.43 to 0.67) in hospitalised adults catheterised for less than one week. At greater than one week of catheterisation the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.64, 95% CI 0.51 to 0.80). The randomised cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3 per cent and 35.5 per cent.

Antibiotic impregnated catheters, compared to standard catheters, were found to lower the rate of asymptomatic bacteriuria in the antibiotic group at less than one week of catheterisation for both minocycline and rifampicin (RR 0.36, 95% CI 0.18 to 0.73), and nitrofurazone (RR 0.52, 95% CI 0.34 to 0.78). However, at greater than one week the results were not statistically significant. One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with six of 68 who had standard catheters (RR 0.20, 95% CI 0.03 to 1.63).

Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate bacteriuria. Individual trials were too small to show whether or not one type of standard catheter reduced the risk of bacteriuria compared with another type of standard catheter.

Authors' conclusions:

The results suggest that the use of silver alloy indwelling catheters for catheterising hospitalised adults short-term reduces the risk of catheter associated bacteriuria. Further evaluation is required to confirm if the benefits translate clinically to a reduction in symptomatic urinary tract infection risk, and if this is cost effective considering the increased cost of silver alloy catheters. Catheters impregnated with antibiotics are also beneficial in reducing bacteriuria in hospitalised adults catheterised for less than one week but there was insufficient data to draw conclusions about those catheterised for longer. Further studies are required to assess the effects of antibiotic impregnated catheters on the risk of symptomatic urinary tract infection. There was not enough evidence to suggest whether or not any standard catheter was better than another in terms of reducing the risk of bacteriuria in hospitalised adults catheterised short-term. Siliconised catheters may be less likely to cause urethral side effects in men; however, this result should be interpreted with some caution as the trials were small and the outcome definitions and specific catheters compared varied.

This record should be cited as:

Schumm K, Lam TBL. Types of urethral catheters for management of short-term voiding problems in hospitalised adults. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004013. DOI: 10.1002/14651858.CD004013.pub3

Assessed as up to date:

May 24, 2010

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Primary Review Group:

Incontinence Group

Health topics:

Gynaecology > Urinary incontinence > Mechanical treatment

Urology > Incontinence > Mechanical treatment

Urology > Urological procedures

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Types of urinary catheters for management of short term voiding problems in hospitalised adults

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