Safety and efficacy of a novel silver-impregnated urinary catheter system for preventing catheter-associated bacteriuria: a pilot randomized clinical trial

Abstract

Background: The purpose of this study was to evaluate the safety of a novel silver-impregnated Foley catheter system designed to prevent catheter-associated bacteriuria and funguria, assess recruitment feasibility for a future pivotal trial, and preliminarily assess efficacy.

Methods: This single-center, randomized controlled trial at a university hospital involved adult neurosurgical patients expected to have a urinary catheter for ≥24 hours. Subjects were randomized to a novel silver-impregnated (test) Foley catheter system or a control system. They were followed for 30 days (or until discharge) while catheterized and for up to 48 hours after catheter removal, with daily bacteriuria testing and assessment for symptoms of infection and catheter intolerance.

Results: Ninety-five subjects were randomized (intention-to-treat [ITT] population). Of these, 61 subjects (64%) had a catheter for ≥24 hours without perioperative antibiotics beyond 24 hours (evaluable population). In the ITT population, 11 of 95 (12%) subjects had an asymptomatic bacteriuria (ABU) event. Compared with controls, test system recipients had a trend toward longer time to ABU in the ITT population (P = .08, log-rank test) and a longer time to ABU in the evaluable population (P = .03). All 6 ABU events caused by gram-negative bacilli occurred in the control group.

Conclusion: In this pilot randomized trial the test system was well tolerated and seemingly effective in preventing catheter-associated bacteriuria, especially with gram-negative bacilli. A pivotal study is warranted.

Trial registration: ClinicalTrials.gov NCT01681511.

Keywords: Catheter-associated bacteriuria; Foley catheter; Ionic silver; Urinary tract infection.

Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Figures

Figure 1. Catheter configuration

A) Components of the accessory device positioned between the catheter and the collection system. The device includes, in series, an anti-reflux valve and an antimicrobial matrix made of polyurethane polymer impregnated with silver and copper B) Photograph (left) and diagram (right) of the silver-coated catheter. The shaded portion of the diagram represents the areas that are coated in silver.

Figure 2

Clinical trial overview.

Figure 3. Time to asymptomatic bacteriuria (ABU) for intention-to-treat (ITT) population (top) and evaluable population (bottom)

According to the log rank text, time to ABU among test system recipients (solid line) vs. control subjects (dashed line) was borderline significantly longer in the ITT population (top), and significantly longer in the evaluable population (bottom).