rifampin and Urination-Disorders

Urinary tract infection (UTI) is the most common hospital-acquired infection. The major associated cause is indwelling urethral catheters. Several measures have been introduced to reduce catheter-associated urinary tract infections (CAUTIs). One of these measures is the introduction of specialised urethral catheters that have been designed to reduce the risk of infection. These include antiseptic-coated and antimicrobial-impregnated catheters.. The primary objective of this review was to compare the effectiveness of different types of indwelling urethral catheters in reducing the risk of UTI and to assess their impact on other outcomes in adults who require short-term urethral catheterisation in hospitals.. We searched the Cochrane Incontinence Group's Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 9 September 2014). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials.. We included all randomised controlled trials (RCTs) and quasi-RCTs comparing types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. 'Short-term' is defined as a duration of catheterisation which is intended to be less than or equal to 14 days.. 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.. 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 inclu. Silver alloy-coated catheters were not associated with a statistically significant reduction in symptomatic CAUTI, and are considerably more expensive. Nitrofurazone-impregnated catheters reduced the risk of symptomatic CAUTI and bacteriuria, although the magnitude of reduction was low and hence may not be clinically important. However, they are more expensive than standard catheters. They are also more likely to cause discomfort than standard catheters.

Topics: Adult; Alloys; Anti-Infective Agents, Urinary; Catheter-Related Infections; Catheters, Indwelling; Humans; Minocycline; Nitrofurazone; Randomized Controlled Trials as Topic; Rifampin; Silver; Urinary Catheterization; Urinary Tract Infections; Urination Disorders

Topics: Anti-Bacterial Agents; Antitubercular Agents; Biopsy, Fine-Needle; Child; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Fever; Humans; Isoniazid; Laparotomy; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculoma; Tuberculosis, Urogenital; Ultrasonography, Interventional; Urination Disorders