At least two review authors independently screened abstracts, extracted data and assessed risk of bias of the included trials. Any disagreement was resolved by discussion or consultation with a third party. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the quality of evidence using the GRADE approach.
MAIN RESULTS: Twenty-six trials met the inclusion criteria involving 12,422 hospitalised adults in 25 parallel group trials, and 27,878 adults in one large cluster-randomised cross-over trial. No trials compared one
antiseptic catheter versus another, nor an antimicrobial
catheter versus another.
Antiseptic-coated indwelling
urethral catheters versus standard indwelling urethral cathetersThe primary outcome, symptomatic CAUTI was reported in one large trial with a low risk of bias, comparing
silver alloy hydrogel-coated
latex catheter (
antiseptic-coated) against a standard
polytetrafluoroethylene (
PTFE)-coated
latex catheter (control). The trial used a pragmatic, US Centers for Disease Control and Prevention (CDC)-based definition for symptomatic CAUTI. For the comparison between
silver alloy-coated
catheter versus standard
catheter, there was no significant difference in symptomatic CAUTI incidence (RR 0.99, 95% CI 0.85 to 1.16).For secondary outcomes, the included trials reported on two types of
antiseptic catheters (coated with either
silver oxide or
silver alloy). For the outcome of
bacteriuria,
silver oxide catheters were not associated with any statistically significant reduction (RR 0.90, 95% CI 0.72 to 1.13). These
catheters are no longer manufactured.
Silver alloy catheters achieved a slight but statistically significant reduction in
bacteriuria (RR 0.82, 95% CI 0.73 to 0.92). However, the one large trial with a low risk of bias did not support this finding (RR 0.99, 95% CI 0.85 to 1.16). The randomised cross-over trial of
silver alloy catheters versus standard
catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial showed less
bacteriuria in the
silver alloy catheter group.For the outcome of discomfort whilst the
catheter was in-situ, fewer patients with
silver alloy catheters complained of discomfort compared with standard
catheters (RR 0.84, 95% CI 0.74 to 0.96). Antimicrobial-impregnated indwelling
urethral catheters versus standard indwelling urethral cathetersThe primary outcome measure, symptomatic CAUTI was reported in one large trial with a low risk of bias, comparing
nitrofurazone-impregnated
silicone catheter (antimicrobial-impregnated) against a standard
PTFE-coated
latex catheter (control). The
nitrofurazone catheter achieved a reduction in symptomatic CAUTI incidence which was of borderline statistical significance (RR 0.84, 95% CI 0.71 to 0.99).For secondary outcomes, the included trials reported on two types of antimicrobial
catheters (impregnated with either
nitrofurazone or
minocycline/
rifampicin). Antimicrobial-impregnated
catheters, compared with standard
catheters, were found to lower the rate of
bacteriuria in the antimicrobial group for both
minocycline and
rifampicin (RR 0.36, 95% CI 0.18 to 0.73), and
nitrofurazone (RR 0.73, 95% CI 0.64 to 0.85). The
minocycline and
rifampicin catheter is no longer manufactured.For the outcome of discomfort whilst the
catheter was in-situ, more patients with
nitrofurazone catheters complained of
pain whilst the
catheter was in-situ compared with standard
catheters (RR 1.26, 95% CI 1.12 to 1.41). For the period after
catheter removal, more patients with
nitrofurazone catheters complained of
pain than standard
catheters (RR 1.43, 95% CI 1.30 to 1.57). Antimicrobial-impregnated indwelling
urethral catheters versus
antiseptic-coated indwelling urethral cathetersOne large trial compared antimicrobial-impregnated (
nitrofurazone)
catheters versus
silver alloy-coated (
antiseptic-coated)
catheters. The results showed people were less likely to have a symptomatic CAUTI with
nitrofurazone-impregnated
catheters (228/2153, 10.6%) compared with
silver alloy-coated
catheters (263/2097, 12.5%), but this was of borderline statistical significance (RR 0.84, 95% CI 0.71 to 1.00). They did, however, have significantly less
bacteriuria (RR 0.78, 95% CI 0.67 to 0.91),While the
catheter was in-situ (RR 1.50, 95% CI 1.32 to 1.70), and on removal (RR 1.32, 95% CI 1.20 to 1.45),
nitrofurazone catheters were associated with more discomfort compared with
silver-coated
catheters. One type of standard indwelling
urethral catheter versus another type of standard indwelling urethral catheterNone of the trials comparing standard
catheters versus other types of standard
catheters measured symptomatic CAUTI. In terms of reducing
bacteriuria, individual trials were too small to show whether one type of standard
catheter was superior to another type. For the outcome of urethral reactions, fully siliconised
catheters appeared to be superior to
latex-based
catheters. However, the trials involved small numbers of participants. There were no statistically significant differences between the different
catheters for all other outcomes.
AUTHORS' CONCLUSIONS: