Infection risk with nitrofurazone-impregnated urinary catheters in trauma patients: a randomized trial.

Abstract

BACKGROUND:

Urinary tract infection is one of the most common nosocomial infections in hospitalized patients. It is predominantly associated with indwelling urinary catheters.

OBJECTIVE:

To determine whether nitrofurazone-impregnated urinary catheters reduce the incidence of catheter-associated bacteriuria and funguria (CABF).

DESIGN:

Randomized, double-blind, controlled trial.

SETTING:

Copenhagen Trauma Center, Copenhagen, Denmark.

PATIENTS:

212 consecutive adult trauma patients admitted between July 2003 and August 2005. Eligible patients needed a urinary catheter on arrival and were excluded if they were HIV positive, were pregnant, had a primary burn injury, or were receiving steroid treatment or if informed consent was unattainable.

INTERVENTIONS:

Nitrofurazone-impregnated or standard silicone catheter throughout the duration of catheterization.

MEASUREMENTS:

Catheter-associated bacteriuria and funguria, defined as at least 10(3) colony-forming units/mL, was assessed daily until removal of the catheter, with a prespecified minimum of 24-hour follow-up for the primary analysis. The microbiologist was blinded to study group assignment.

RESULTS:

1190 urine cultures were obtained over 1001 catheter-days. Catheter-associated bacteriuria and funguria occurred less frequently in the nitrofurazone catheter group than in the silicone catheter group (7 of 77 [9.1%] vs. 19 of 77 [24.7%]; incidence per 1000 catheter-days, 13.8 vs. 38.6; adjusted risk, 0.31 [95% CI, 0.14 to 0.70]; P = 0.005). Onset of CABF was delayed in the nitrofurazone group (P = 0.01), and nitrofurazone catheters led to fewer instances of new or changed antimicrobial therapy (adjusted risk, 0.27 [CI, 0.10 to 0.69]; P = 0.006).

LIMITATIONS:

The clinical significance of asymptomatic bacteriuria and funguria is unclear. Data were missing in 27% of patients, and the magnitude of effect of the nitrofurazone catheters varied by assumptions about outcomes in patients who did not complete 24-hour follow-up.

CONCLUSIONS:

Nitrofurazone-impregnated urinary catheters reduced the incidence of CABF in adult trauma patients, reducing the need to change or prescribe new antimicrobial therapy. ClinicalTrials.gov registration number: NCT00192985.

• Authors: Jakob Stensballe, Michael Tvede, Dagnia Looms, Freddy Knudsen Lippert, Benny Dahl, Else Tønnesen, Lars Simon Rasmussen
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 147 Issue 5 Pg. 285-93 (Sep 04 2007) ISSN: 1539-3704 [Electronic] United States
• PMID: 17785483 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents, Urinary
• Nitrofurazone

Topics

• Adult
• Anti-Infective Agents, Urinary (administration & dosage)
• Bacterial Infections (prevention & control)
• Catheters, Indwelling (adverse effects)
• Double-Blind Method
• Female
• Humans
• Male
• Mycoses (prevention & control)
• Nitrofurazone (administration & dosage)
• Urinary Catheterization (adverse effects)
• Urinary Tract Infections (prevention & control)
• Wounds and Injuries (therapy)