Antimicrobial catheter coatings decrease the incidence of urinary tract infection (UTI), according to a recent study published in the Urology Practice.
Catheter-associated urinary tract infections comprise a significant burden to the health care system and are of major concern for indwelling catheter use.
Catheter coatings have been studied for their potential to reduce risk of infection. The purpose of this meta-analysis is to determine the efficacy of coated catheters across clinical studies in preventing these common nosocomial infections. Searches were conducted on PubMed Central® and ScienceDirect using the terms "catheter," "urinary tract infection" and "coated" or "antimicrobial." Articles included were prospective randomized clinical studies of coated (experimental) vs uncoated (control) catheters published in English between the years 2000 and 2020. Results from included studies were analyzed using Fisher's exact test and conditional logistic regression.
The Results of the study are as follows: Fifteen studies met the inclusion criteria. Tested urinary catheter coatings include silver, silver salt, nitrofurazone and metal-alloy. Conditional logistic regression (p <0.001) shows statistically significant negative association between coated catheter use and the incidence of catheter-associated urinary tract infections. The odds ratio of 0.80 and 95% confidence interval (0.74, 0.88) support protective effect of catheter coatings.
The limitation of the study is that although the authors of this meta-analysis seem to think so, it is obvious to this reviewer that the case has not been proven. As the authors point out, to qualify for a diagnosis of CAUTI, a patient must have UTI-associated symptoms and at least >103 CFU/mL. More than half of the 15 selected studies in this meta-analysis reported only various cutoff levels of bacteriuria (and not symptoms), and, although arguably this increases the risk of a symptomatic UTI, it does not actually represent a clinically important CAUTI. Of the 15 studies, 10 did not demonstrate a statistically significant association of catheter coating and the incidence of CAUTIs or bacteriuria, and, in fact, only 2 of the 5 positive studies had an acceptable definition of CAUTI.
Thus, the researchers concluded that meta-analysis demonstrates a negative association of coated catheter and incidence of catheter-associated urinary tract infections, supporting that antimicrobial catheter coatings decreases incidence of infection across studies. Further clinical research is recommended to determine the potential for catheter coating adoption in clinical practice to reduce catheter-associated urinary tract infection risk and incidence.
Reference:
Use of Antimicrobial-Coated Catheters in Preventing Catheter-Associated Urinary Tract Infections and Bacteriuria: A Meta-Analysis for Clinicians by Rachel Vopni et al. published in the Urology Practice.
https://doi.org/10.1097/UPJ.0000000000000254