disilver-oxide and Bacteriuria

Urinary tract infections (UTIs) represent the second most often observed infectious diseases in community, following the respiratory tract infections. In the United States, these infections account for up to 7 million/year of visits, with a mean yearly expense for the related antibiotic treatment that has been estimated in more than one billion dollars. In nosocomial setting, UTIs represent the most frequent diseases, whose incidence equates 40% of nosocomial infections overall considered; about 80% of UTIs is related to urinary catheterization. In the present review, the authors, after a brief introduction about epidemiology, pathogenesis and aetiology of urinary tract infections, consider two particular settings: long term care facilities, where UTIs represent the most often diagnosed and treated infections, and the Intensive Care Units where occurrence of urinary tract infections represents an especially frequent event as well. Patients referred to both these settings are particular, as they undergo, in most cases, to urinary catheterization. After describing the pathogenesis of UTIs related to catheterization, either short- or long term, the authors consider the different currently available catheters, focusing on silver-coated and silver alloy coated (silver, gold, and platinum). With regard to this latter issue, results presented by a number of papers in the literature are reported, where clinical experiences following the use of these urinary catheters are described. In their conclusion, authors suggest the opportunity to increase any prevention strategy able to reduce the incidence of infections related to urinary catheterization and its consequences, as a more rational length and modality of catheterization, in addition to the use of innovative catheters.

Topics: Aged; Alloys; Bacteriuria; Biofilms; Coated Materials, Biocompatible; Critical Care; Enterobacteriaceae Infections; Equipment Contamination; Female; Humans; Hydrogels; Long-Term Care; Male; Multicenter Studies as Topic; Oxides; Randomized Controlled Trials as Topic; Risk Factors; Silver Compounds; Urethra; Urinary Catheterization; Urinary Tract Infections

The antibacterial activity of silver-containing compounds has recently been employed in constructing medical devices, such as vascular and urinary catheters, that may be effective in blocking infection. The present study was designed to evaluate the efficacy of a silver oxide-coated urinary catheter.. A total of 1,309 hospitalized patients who required placement of an indwelling urinary catheter for 24 hours or longer were randomly assigned to receive either a silicone catheter coated externally with 5% silver oxide or a standard silicone elastomer-coated latex catheter. Daily catheter-urine specimens were collected aseptically and catheter-care violations were monitored daily for the duration of the catheterization.. Bacteriuria developed in 85 of 745 patients (11.4%) in the silver-coated catheter group and in 73 of 564 patients (12.9%) in the control group (P = 0.45). In women who did not receive antibiotics, the rates were 29.3% and 30.4%, respectively (P = 0.98). In men who did not receive antibiotics, the rate of bacteriuria was significantly higher with the silver-coated catheter (29.4% compared to 8.3%, respectively, P = 0.02). Staphylococcal species were isolated more often from the silver-coated catheter group than from the control group (25% versus 8% of all isolates, respectively, P = 0.002).. This study, the largest ever reported evaluating any silver-impregnated device, has not only failed to demonstrate the efficacy of silver in prevention of catheter-associated bacteriuria, as suggested in prior studies, but it has also shown a significantly increased incidence of bacteriuria in male patients and a significantly increased occurrence of staphylococcal bacteriuria. These results suggest the need for caution and for similar large-scale trials before silver-containing compounds are widely used for preventing device-associated infections, both in vascular and urinary catheters.

Topics: Bacteriuria; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Oxides; Risk Factors; Silver Compounds; Staphylococcal Infections; Superinfection; Treatment Failure; Urinary Catheterization

In a prospective clinical trial involving 482 acutely hospitalized patients, the overall incidence of catheter-associated urinary tract infection (UTI; 10%) was similar in recipients of a silver oxide-coated urinary catheter (silver catheter) or a control silicone catheter. However, female sex and absence of antimicrobial use were independently associated with an increased risk of UTI. After stratification for these variables, the silver catheter reduced the incidence of UTI among women not receiving antimicrobial agents (19% for control catheter vs. 0 for silver catheter, P = .04; confidence interval for the difference in incidence, 0.4%-38%) but not in the other subgroups. Gram-positive UTI was associated with absence of antimicrobial use, the control catheter, and catheter care violations. Gram-negative and candidal UTIs were more common after 7 days of catheterization, and candidal UTI was associated with being female and antimicrobial use. These findings demonstrate that several clinical variables influenced the incidence and microbiology of catheter-associated UTI and that the silver catheter appeared to prevent UTI among women not receiving antimicrobials.

Topics: Adult; Bacteriuria; Catheters, Indwelling; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Multivariate Analysis; Oxides; Prospective Studies; Regression Analysis; Sex Factors; Silver; Silver Compounds; Urinary Catheterization; Urinary Tract Infections; Yeasts

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.

Topics: Adult; Bacteria; Bacteriuria; Catheters, Indwelling; Critical Care; Cystitis; Equipment Contamination; Female; Humans; Male; Oxides; Silver; Silver Compounds; Spinal Cord Injuries; Triazines; Urethra; Urinary Bladder

Topics: Anti-Infective Agents, Urinary; Bacteriuria; Humans; Male; Oxides; Silver; Silver Compounds; Triazines; Urinary Catheterization