We assessed the efficacy of
silver oxide coating of the indwelling
urethral catheter and
catheter adapter, and instillation of
trichloroisocyanuric acid into the urinary drainage bag in the prevention of
catheter-associated
bacteriuria in a prospective and randomized study of 74 patients.
Bacteriuria was documented in 29 of the 74 patients (39 per cent). There was a significant difference between the attack rates, with 11 of 41 patients (27 per cent) in the test group and 18 of 33 (55 per cent) in the control group having
bacteriuria (p equals 0.02) after a median time to
bacteriuria of 36 and 8 days, respectively (p equals 0.01). Urethral meatal colonization was implicated as the source of bladder
bacteriuria in 12 of 18 patients (67 per cent) in the control group and 5 of 11 (45 per cent) in the test group.
Trichloroisocyanuric acid significantly reduced drainage bag contamination but bag contamination with the same microorganism responsible for
bacteriuria preceded
infection in only 2 of the 29 patients (7 per cent), 1 in each group. Patients who received systemic
antimicrobial agents acquired
bacteriuria less frequently than those who did not. The apparent protective effect of systemic antimicrobials was strongest during the first 4 days of catheterization. The data indicate that episodes of
bacteriuria arising from the urethral meatus are common among catheterized patients and that the antimicrobial
catheter is effective in reducing the incidence of
catheter-associated
bacteriuria.