Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-26T02:26:58.808Z Has data issue: false hasContentIssue false
  • English
  • Français

A Prospective Trial of a Novel, Silicone-Based, Silver-Coated Foley Catheter for the Prevention of Nosocomial Urinary Tract Infections

Published online by Cambridge University Press:  21 June 2016

Arjun Srinivasan ,
Tobi Karchmer ,
Ann Richards ,
Xiaoyan Song  and
Trish M. Perl
Arjun Srinivasan*
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Tobi Karchmer
Affiliation:
Department of Medicine, Section of Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, North Carolina
Ann Richards
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Xiaoyan Song
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Trish M. Perl
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-35, Atlanta, GA30333 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the efficacy of silicone-based, silver ion–impregnated urinary catheters in the prevention of nosocomial urinary tract infections (NUTIs).

Design.

Prospective, crossover study to compare the efficacy of a silicone-based, hydrogel-coated, silver-impregnated Foley catheter with that of a silicone-based, hydrogel-coated catheter in the prevention of NUTIs.

Setting.

Adult medical and surgical wards of a university teaching hospital.

Results.

A total of 3,036 patients with catheters were evaluated; 1,165 (38%) of the catheters were silver impregnated, and 1,871 (62%) were not silver impregnated. Study groups were not identical; there were more men, a shorter duration of catheterization, and fewer urine cultures per 1,000 catheter-days in the silver catheter group. The rate of NUTIs per 1,000 Foley-days was 14.29 in the silver catheter group, compared with 16.15 in the nonsilver catheter group (incidence rate ratio, 0.88; 95% confidence interval, 0.70-1.11; P = .29). The median length of catheterization prior to the onset of a urinary tract infection (ie, exposure time) was 4 days for each group. There were no differences in the recovery of gram-positive, gram-negative, or fungal organisms in NUTIs. In a multivariate survival analysis, no factors, including silver catheters, were protective against NUTI.

Conclusions.

Unlike previous trials of latex-based, silver ion–impregnated Foley catheters, we found that silicone-based, silver-impregnated Foley catheters were not effective in preventing NUTIs; however, this study was affected by differences in the study groups. Prospective trials remain important in assessing the efficacy and cost-effectiveness of new silver-coated products.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 1 , January 2006 , pp. 38 - 43
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985; 121:159–167.CrossRefGoogle Scholar
2.Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catherized patients. Arch Intern Med 2000; 160:678–682.CrossRefGoogle Scholar
3.Platt, R, Polk, BF, Murdock, B, Rosner, B. Mortality associated with nosocomial urinary tract infection. N Engl J Med 1982; 307:637–642.Google Scholar
4.Weinstein, MP, Towns, ML, Quarterly, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24:584–602.Google Scholar
5.Bryan, CS, Reynolds, KL. Hospital acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol 1984; 132:494–498.Google Scholar
6.Krieger, JN, Kaiser, DL, Wenzel, RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis 1983; 148:57–62.CrossRefGoogle ScholarPubMed
7.Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002; 23:27–31.Google Scholar
8.Classen, D. Assessing the effect of adverse hospital events on the cost of hospitalization and other patient outcomes [dissertation]. Salt Lake City: University of Utah; 1993.Google Scholar
9.Karchmer, TB, Gianetta, ET, Muto, CA, Strain, BA, Farr, BA. A randomized crossover study of silver coated urinary catheters in hospitalized patients. Arch Intern Med 2000; 160:3294–3298.CrossRefGoogle ScholarPubMed
10.Jarlier, V, Fosse, T, Philippon, A. Antibiotic susceptibility in aerobic gram negative bacilli isolated in 39 French teaching hospitals. Intensive Care Med 1996; 22:1057–1065.Google Scholar
11.Schaberg, DR, Haley, RW, Highsmith, AK, Anderson, RL, McGowan, JE. Nosocomial bacteriuria: a prospective study of case clustering and antimicrobial resistance. Ann Intern Med 1980; 93:420–424.Google Scholar
12.Naber, KG, Witte, W, Bauernfeind, A, et al. Clinical significance and spread of fluoroquinolone resistant uropathogens in hospitalized urologic patients. Infection 1994; 22:S122–S127.CrossRefGoogle Scholar
13.Paradisi, F, Corti, G, Mangani, V. Urosepsis in the critical care unit. Crit Care Clin 1998; 14:165–180.Google Scholar
14.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. JAMA 1995; 274:639–644.CrossRefGoogle ScholarPubMed
15.Lai, KK, Fontecchio, SA. Use of silver-hydrogel urinary catheters on the incidence of catheter associated urinary tract infections in hospitalized patients. Am J Infect Control 2002; 30:221–225.Google Scholar
16.Liedberg, H, Lundberg, T. Silver alloy coated catheters reduce catheter associated bacteriuria. Brit J Urol 1990; 65:379–381.CrossRefGoogle ScholarPubMed
17.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140 [published erratum appears in Am J Infect Control 1988; 16:177].Google Scholar
18.Miller, A, Linton, KB, Gillespie, WA, Slade, N, Mitchell, JP. Catheter drainage and infection in acute retention of urine. Lancet 1960; 1:310–312.Google Scholar
19.Desautels, RE. Aseptic management of catheter drainage. N Engl J Med 1960; 263:189–191.Google Scholar
20.Saint, S, Lipsky, BA. Preventing catheter related bacteriuria: Should we? Can we? How? Arch Intern Med 1999; 159:800–808.Google Scholar
21.Johnson, JR, Delavari, P, Azar, M. Activities of a nitrofurazone containing urinary catheter and a silver hydrogel catheter against multidrug resistant bacteria characteristic of catheter associated urinary tract infection. Antimicrob Agents Chemother 1999; 43:2990–2995.Google Scholar
22.Dariouche, RO, Safar, H, Raad, II. In vitro efficacy of antimicrobial-coated bladder catheters in inhibiting bacterial migration along catheter surfaces. J Infect Dis 1997; 176:1109–1112.Google Scholar
23.Dariouche, RO, Smith, JA, Hanna, H, et al. Efficacy of antimicrobial impregnated bladder catheters in reducing catheter associated bacteriuria: a prospective, randomized, multicenter clinical trial. Urology 1999; 54: 976–981.Google Scholar
24.Spadaro, JA, Berger, TJ, Barranco, SD, Chapin, SE, Becker, RO. Antibacterial effects of silver electrodes with weak direct current. Antimicrob Agents Chemother 1974; 6:637–642.Google Scholar
25.Ahearn, DG, Grace, DT, Jennings, MJ, et al. Effects of hydrogel/silver coatings on in vitro adhesion to catheters of bacteria associated with urinary tract infections. Curr Microbiol 2000; 41:120–125.Google Scholar
26.Riley, DK, Classen, DC, Stevens, LE, Burke, JP. A large randomized clinical trial of a silver impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med 1995; 98:349–356.Google Scholar
27.Johnson, JR, Roberts, PL, Olsen, RJ, Moyer, KA, Stamm, WE. Prevention of catheter associated urinary tract infection with a silver-oxide coated urinary catheter: clinical and microbiologic correlates. J Infect Dis 1990; 162:1145–1150.CrossRefGoogle ScholarPubMed
28.Liedberg, H, Lundberg, T, Ekman, P. Refinements in the coating of urethral catheters reduces the incidence of catheter associated bacteriuria. Eur Urol 1990; 17:236–240.Google Scholar
29.Verleyen, P, De Ridder, D, Van Poppel, H. Clinical application of the Bardex IC Foley catheter. Eur Urol 1999; 36:240–246.Google Scholar
30.Thibon, P, Le Coutour, X, Leroyer, R, Fabry, J. Randomized multi-centre trial of the effects of a catheter coated with hydrogel and silver salts on the incidence of hospital acquired urinary tract infections. J Hosp Infect 2000; 45:117–124.Google Scholar
31.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; 105:236–241.CrossRefGoogle ScholarPubMed
32.Saint, S, Veenstra, DL, Sullican, SS, Chenoweth, C, Fendrick, M. The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Arch Intern Med 2000; 160:2670–2675.Google Scholar
33.Turjanmaa, K, Alenius, H, Rennuala, T, Palosuo, T. Recent developments in latex allergy. Curr Opin Allergy Clin Immunol 2002; 2:407–412.Google Scholar
34.Hepner, DL, Castells, MC. Latex allergy: an update. Anesth Analg 2003; 96:1219–1229.Google Scholar
35.Krieger, JN, Kaiser, DL, Wenzel, RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis 1983; 148:57–62.CrossRefGoogle ScholarPubMed
36.Sheng, WH, Ko, WJ, Wang, JT, Chang, SC, Hsuch, PR, Luh, KT. Evaluation of antiseptic impregnated central venous catheters for prevention of catheter related infection in intensive care unit patients. Diagn Microbiol Infect Dis 2000; 38:1–5.CrossRefGoogle ScholarPubMed
37.Walder, B, Pittet, D, Tramer, MR. Prevention of bloodstream infections with central venous catheters treated with anti-infective agents depends on catheter type and insertion time: evidence from a meta-analysis. Infect Control Hosp Epidemiol 2002; 23:748–756.Google Scholar
38.Hartmann, M, Guttmann, J, Muller, B, Hallmann, T, Geiger, K. Reduction of the bacterial load by the silver coated endotracheal tube (SCET), a laboratory investigation. Technol Health Care 1999; 7:359–370.Google Scholar