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Antimicrobial urinary catheters: a systematic review

Catheter-associated urinary tract infection (CAUTI) is a common occurrence, often clinically unapparent and with a benign course. However, in a small fraction of patients catheter-associated bacteriuria/funguria (CABF) produces overt clinical manifestations and adverse consequences, including (at the extreme end of the spectrum) urosepsis and death. Antimicrobial-coated catheters have been proposed as a method to prevent CAUTI and are in use worldwide, although their clinical efficacy is not well known. Randomized and quasi-randomized clinical trials have demonstrated that antimicrobial-coated catheters do decrease the incidence of CABF; however, evidence that such devices provide clinically meaningful benefit is lacking. Moreover, uncertainty exists as to which of the currently marketed catheters is most effective against CABF, since no published trial has directly compared different antimicrobial-coated catheters. We conducted a systematic review to summarize and evaluate existing evidence, and to address areas of uncertainty. We found consistent but variable evidence that antimicrobial-coated catheters prevent CABF during short-term catheterization; however, no study demonstrated a clinical benefit. Future efforts in this field should include randomized trials with clinically relevant end points, as well as research to develop improved mechanisms for bladder drainage, preferably without the risks and discomfort currently associated with urinary catheters.