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Management of short term indwelling urethral catheters to prevent urinary tract infections
Search terms for each database are listed in the paper. The reference lists and bibliographies of retrieved studies were scanned for further relevant articles. Evaluations of short term indwelling urethral catheters were defined as studies that collected data from day 1 to day 14 of catheterisation.
Outcomes assessed in the reviewThe difference in UTI and bacteriuria between the experimental intervention and control. UTI was defined as (a) at least 10^5 colony forming units per ml or (b) at least 10^4 colony forming units per ml, with clinical indications of UTI such as pyrexia (at least 38 degrees) or supra pubic tenderness. Bacteriuria was defined as at least 1000 colony forming units per ml.
How were decisions on the relevance of primary studies made?The titles, abstracts and descriptor/MeSH terms of retrieved articles were assessed for relevance to the review. Criteria included randomisation, interventions, outcomes, baseline comparability, blinding and follow up. No validity checklist was used to assess the quality of the non RCTS included in the narrative summary.
Methods of synthesis
How were the studies combined?Where possible, results from RCTs were statistically combined. Otherwise, they were summarised and included in a narrative synthesis of the appropriate intervention, along with the findings of non RCTs. They also intended to undertake subgroup analyses for gender, age and period of time urethral catheters were insitu.
Results of the review
Eighteen RCTs (n=7167) were included in the analysis.
A number of the included RCTs had methodological problems including small sample sizes and high drop out rates. Peto odds ratios and 95% CIs were calculated for each included RCT. All odds ratios (ORs) shown are based on the results of a single trial, unless otherwise stated.
1. Catheterisation technique. There was no significant difference in infection rate between groups receiving clean catheterisation and those receiving sterile catheterisation (1 trial: OR 0.85 (95% CI: 0.30, 2.38)).
2. Meatal care. There were Cheap Oakley Sunglasses no significant differences in bacteriuria between povidone iodine (PVI) meatal care and standard care (OR 1.35 (95% CI: 0.76, 2.37)) or between green soap and water and standard care (OR 1.57 (95% CI: 0.86, 2.89)). There was no significant difference in bacteriuria between PVI meatal care and green soap and water (OR 1.37 (95% CI: 0.79, 2.36)). No overall significant differences were found between standard care and noemycin polymixin beta bactracin ointment (OR 0.87 (95%CI: 0.41, 1.82)) or polyantibiotic cream (1 trial: OR 0.65 (95% CI: 0.39, 1.08)).
3. Catheter composition. There were no significant differences between silicone and latex catheters for bacteriuria (1 trial: OR 1.07 (95% CI: 0.21, 5.54)). Incidence of infection with silver coated latex foley catheters was significantly lower than with teflonised latex foley catheters (1 trial: OR 0.23 (95% CI: 0.10, 0.53)).
4. Bladder irrigation. PVI bladder instillation significantly reduced bacteriuria compared to no instillation (1 trial: OR 0.17 (95% CI: 0.04, 0.70)).
5. Drainage systems physical adapters. Overall (2 combined trials), sealed drainage systems did not significantly reduce infection rate compared with unsealed drainage systems (OR 0.90 (95% CI: 0.70, 1.16)). One of these trials did show a reduced incidence of infection among patients not taking antibiotics with sealed catheters versus unsealed catheters (OR 0.32 (95% CI: 0.16, 0.63)). Patients with a hydrophilic coated silicone catheter had a significantly lower rate of bacteriuria than those with a catheter with exchangeable bags (OR 0.12 (95% CI: 0.03, 0.51)).
6. Drainage systems solutions. There was no significant reduction in bacteriuria in patients who had disinfectants added to their drainage bags. This was true for chlorhexidine (OR Cheap Oakley Sunglasses 1.31 (95% CI: 0.47, 3.64)) and hydrogen peroxide (OR 1.22 (95% CI: 0.74, 2.02)). A significant reduction in infection rates was seen for added trichloroisocyanuric acid when combined with a silver oxide coated catheter and adapter (OR 0.32 (95% CI: 0.12, 0.18)).
7. Drainage systems combined seal and solution. A closed drainage system with PVI releasing cartridge, hydrophilic surface coated catheter, anti reflux mechanism and tamper discouraging seal significantly reduced UTI compared to a closed drainage system Cheap Oakley Sunglasses with only one preventative measure (1 trial: OR 0.26 (95% CI: 0.09, 0.75)).
8. Indwelling vs. intermittent cathe Cheap Oakley Sunglasses terisation. There appeared to be a slightly reduced level of bacteriuria with ‘in out’ catheters (1 trial: OR 2.56 (95% CI: 1.00, 7.08)).
9. Care delivery. There was no significant difference in bacteriuria between one day and three days of post operative catheterisation following either vaginal plastic surgery (0.67 (95% CI: 0.30, 1.49)) or retropubic incontinence surgery (0.48 (95% CI: 0.19, 1.20)).