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Daily Meatal Care for Prevention of Catheter-Associated Bacteriuria Results Using Frequent Applications of Polyantibiotic Cream

Published online by Cambridge University Press:  21 June 2016

David C. Classen ,
Robert A. Larsen ,
John P. Burke ,
David W. Alling  and
Lane E. Stevens
David C. Classen
Affiliation:
Division of Infectious Disease, Department of Medicine, LDS Hospital and University of Utah School of Medicine, Salt Lake City, Utah
Robert A. Larsen
Affiliation:
Division of Infectious Disease, Department of Medicine, LDS Hospital and University of Utah School of Medicine, Salt Lake City, Utah
John P. Burke*
Affiliation:
Division of Infectious Disease, Department of Medicine, LDS Hospital and University of Utah School of Medicine, Salt Lake City, Utah
David W. Alling
Affiliation:
Office of Scientific Director, National Institute of Allergy and infectious Diseases, Bethesda, Maryland
Lane E. Stevens
Affiliation:
Division of Infectious Disease, Department of Medicine, LDS Hospital and University of Utah School of Medicine, Salt Lake City, Utah
*
Division of Infectious Disease, LDS Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84143
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Abstract

Objective:

To determine the efficacy of meatal treatment with a polyantibiotic cream in the prevention of bacteriuria during transurethral bladder catheterization.

Design:

Randomized controlled trial.

Setting:

Community teaching hospital.

Intervention:

Adult patients who underwent closed urinary catheter drainage for short and intermediate durations (two to 30 days).

Intervention:

Polyantibiotic cream containing polymyxin B sulfate, neomycin sulfate, and gramicidin was applied to the urethral meatus-catheter interface three times daily from the first day of catheterization until bacteriuria was found. The onset of bacteriuria was defined as the day the colonizing species first achieved a colony count of >1000 colonies/ml. Patients randomized to the control group received routine meatal care with cleansing of the meatal surface during daily bathing.

Results:

Among 2,923 patients who were randomly allocated to receive either the protocol meatal care or routine care, the evaluable study population consisted of 747 patients who were nonbacteriuric and who remained catheterized for more than two days. Overall, 26 (6.8%) of 383 patients given the polyantibiotic treatment acquired bacteriuria, as compared to 37 (10.1%) of 364 patients not given this treatment (p = .167). A Cox proportional hazards regression analysis showed that, among putative risk factors including lack of meatal care, only female gender, a meatal swab culture yielding gram-negative rods or enterococci, and lack of antibiotic use during catheterization were independently associated with the development of bacteriuria.

Conclusions:

The adverse effect of meatal care noted in earlier studies of a disinfectant ointment applied twice daily was not found in this study of an antimicrobial preparation in a cream vehicle applied three times daily. However, the results do not support meatal care as an efficacious method to prevent catheter-associated bacteriuria in all patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 3 , March 1991 , pp. 157 - 162
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate. A need for vital statistics. Am J Epidemiol. 1985;121:159–167.CrossRefGoogle Scholar
2. Martin, CM, Vaquer, F, Myers, MS, El-Dadah, A. Prevention of gram-negative rod bacteremia associated with indwelling urinary tract catheterization. Antimicrob Agents Chemother. 1963;3:617–623.Google Scholar
3. Piatt, R, Polk, BE Murdock, B, Rosner, B. Mortality associated with nosocomial urinary tract infection. N Engl J Med. 1982;307:637–642.Google Scholar
4. Platt, R, Polk, BE Murdock, B, Rosner, B. Reduction of mortality associated with nosocomial urinary tract infection. Lancet. 1983;2:893–897.10.1016/S0140-6736(83)91327-2CrossRefGoogle Scholar
5. Bryan, CS, Reynolds, KL. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol. 1984; 132:494–498.10.1016/S0022-5347(17)49707-2CrossRefGoogle ScholarPubMed
6. Krieger, JN, Raiser, DL, Wenzel, RI? Nosocomial urinary tract infections: secular trends, treatment, and economics in a university hospital. J Urol. 1983;130:102–106.CrossRefGoogle ScholarPubMed
7. Kass, EH, Schneiderman, LJ. Entry of bacteria into the urinary tracts of patients with inlying catheters. N Engl J Med. 1957;256:556–7.CrossRefGoogle ScholarPubMed
8. Garibaldi, RA, Burke, JP, Britt, MR, Miller, WA, Smith, CB. Meatal colonization and catheter-associated bacteriuria. N Engl J Med. 1980;303:316–318.10.1056/NEJM198008073030605CrossRefGoogle ScholarPubMed
9. Daifuku, IT, Stamm, WE. Association of rectal and urethral colonization with urinary tract infections in patients with indwelling catheters. JAMA. 1984;252:2082–2030.10.1001/jama.1984.03350150028015CrossRefGoogle ScholarPubMed
10. Burke, JP, Garibaldi, RA, Britt, NM, Jacobson, JA, Conti, M, Alling, DW. Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens. Am J Med. 1981;70:655–658.10.1016/0002-9343(81)90591-XCrossRefGoogle ScholarPubMed
11. Burke, JP, Jacobson, JA, Garibaldi, RA, Conti, MT, Alling, DW. Evaluation of daily meatal care with polyantibiotic ointment in prevention of urinary catheter-associated bacteriuria. J Urol. 1983;129:331–334.10.1016/S0022-5347(17)52083-2CrossRefGoogle Scholar
12. Warren, JW, Piatt, R, Thomas, RJ, Rosner, B, Kass, EH. Antibiotic irrigation and catheter-associated urinary tract infection. N Engl J Med. 1978;299:570–583.10.1056/NEJM197809142991103CrossRefGoogle Scholar
13. Garibaldi, RA, Burke, JP, Dickman, ML, Smith, CB. Factors predisposing to bacteriuria during indwelling urethra1 catheterization. N Engl /Med. 1974;291:215–219.CrossRefGoogle ScholarPubMed
14. Thompson, RL, Haley, CE, Searcy, MA, et al. Catheter-associated bacteriuria. Failure to reduce attack rates using periodic instillations of a disinfectant into urinary drainage systems. JAMA. 1984;251:747–751.CrossRefGoogle ScholarPubMed
15. Hartstein, AL, Garber, SB, Ward, TT. Nosocomial urinary tract infection: a prospective evaluation of 108 catheterized patients. Infect Control. 1981;2:380–386.CrossRefGoogle ScholarPubMed
16. Scheckler, WE. Septicemia and nosocomial infections in a community hospital. Ann Intern Med. 1978;89:753–756.10.7326/0003-4819-89-5-754CrossRefGoogle Scholar
17. Kaplan, EL, Meier, P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRefGoogle Scholar
18. Mantel, N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–170.Google ScholarPubMed
19. Cox, DR. Regression models and life tables. Journal of the Royal Statistics Society. 1972;34:187–220.Google Scholar