Antimicrobial catheters

Given the important clinical and economic consequences of catheter-associated urinary tract infection (CAUTI), researchers have tried novel approaches to prevent this common patient safety problem. While the primary preventive focus – as described under “General catheter-associated urinary tract infection (CAUTI) prevention practices” – has been on avoiding the indwelling catheter, using alternatives to the indwelling catheter, and removing the indwelling catheter as soon as possible, investigators have also assessed whether antimicrobial catheters can prevent CAUTI. 

Several clinical and economic studies have evaluated antimicrobial urinary catheters, including individual trials, systematic reviews and meta-analyses.  Economic evaluations are important to consider given the additional cost of antimicrobial catheter trays (approximately $5). 

Different antimicrobial urinary catheters have been evaluated in patients over the past few decades, including silver (either alloy or oxide) and nitrofurazone-releasing catheters.  

A Cochrane Review of antimicrobial catheters conducted in 2008 included 23 trials involving 5236 hospitalized adults in 22 parallel group trials. Schumm and Lam summarized their findings as follows:  “…Silver alloy (antiseptic) coated or nitrofurazone-impregnated (antibiotic) urinary catheters might reduce infections in hospitalized adults … but the evidence was weak.”…Larger, more scientifically rigorous, trials are needed on whether catheters impregnated with antibiotics or antiseptics reduce infection.”

A large and scientifically rigorous trial – involving 24 hospitals in the United Kingdom and about 7000 patients (most of whom were undergoing surgery) – was published in The Lancet. This randomized trial compared three different catheters – silver alloy, nitrofurazone-releasing, and a control (polytetrafluoroethylene–coated latex catheter) – and found no significant difference in rates of symptomatic CAUTI between the silver alloy and control catheters. There was a small decrease in rates of symptomatic CAUTI with the use of nitrofurazone-releasing catheters compared with control, however, this decrease was not deemed to be clinically important. The makers of the nitrofurazone-releasing catheter recently announced that they will discontinue manufacturing and marketing the device.   An accompanying editorial provides a useful perspective on the limitations of this study as well as the role of antimicrobial catheters in patients at high-risk of CAUTI (e.g., neutropenic and severely immune-compromised patients).

Currently, antimicrobial catheters are not recommended for routine use in hospitalized patients.