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Urinary infections are a serious threat to sick inpatients, and they are usually associated with indwelling catheters. There is some evidence that impregnating catheters with antimicrobial agents such as nitrofurazone can help prevent nosocomial infections, and the latest trial extends this evidence to trauma patients from DenmarkDenmark.
In a randomised double blind trial, patients given an impregnated catheter were significantly less likely to develop bacteriuria or funguria than those given regular silicone catheters (9.1% (7/77) v 24.7%, (19/77); adjusted relative risk 0.31, 95% CI 0.14 to 0.70). They were also less likely to need a change of antibiotic or to start new antibiotics. Mortality and length of hospital stay were unaffected.
The trial wasn't perfect—58 (27.4%) patients were omitted from the per protocol analysis, mostly because they died or needed a catheter for less than 24 hours—but the authors did a series of different analyses, most of which suggested that the impregnated catheters were beneficial. Preventing bacteriuria is different from preventing significant infections or sepsis, but the two are related, say the authors. The impregnated catheters were not associated with excess growth of bacteria resistant to nitrofurantoin, the antibiotic most closely related to nitrofurazone.