Materials-based incidence of urinary catheter associated urinary tract infections and the causative micro-organisms: systematic review and meta-analysis

Abstract

Background: Both long (> 30 days) and short-term (≤ 30 days) catheterisation has been associated with urinary tract infections (UTIs) due to the invasive nature of device insertion through the urethra. Catheter associated Urinary Tract Infections (CAUTIs) are common (prevalence of ~ 8.5%) infections which can be treated with antibiotics; however, CAUTIs are both expensive to treat and contributes to the antibiotic usage crisis. As catheters are unlikely be replaced for the management of patients' urination, ways of reducing CAUTIs are sought out, using the catheter device itself. The aim of this review is to assess the incidence of CAUTI and the causative micro-organisms when different urinary catheter devices have been used by humans, as reported in published research articles.

Methods: A Systematic Literature Review was conducted in Ovid Medline, Web of Science and PubMed, to identify studies which investigated the incidence of UTI and the causative micro-organisms, in patients with different urinary catheter devices. The articles were selected based on a strict set of inclusion and exclusion criteria. The data regarding UTI incidence was extracted and calculated odds ratio were compared across studies and pooled when types of catheters were compared. CAUTI causative micro-organisms, if stated within the research pieces, were also gathered.

Results: A total of 890 articles were identified, but only 26 unique articles met the inclusion/exclusion criteria for this review. Amongst the large cohort there were catheters of materials silicone, latex and PVC and catheter modifications of silver nanoparticles and nitrofurantoin antibiotics. The meta-analysis did not provide a clear choice towards a single catheter against another although silver-based catheters, and silver alloy, appeared to statistically reduce the OR of developing CAUTIs. At genus level the three commonest bacteria identified across the cohort were E. coli, Enterococcus spp. and Pseudomonas spp. whilst considering only at the genus level, with E. coli, Klebsiella pneumonia and Enterococcus faecalis most common at the species-specific level.

Conclusions: There does not appear to be a catheter type, which can significantly reduce the incidence of CAUTI's in patients requiring catheterisation. Ultimately, this warrants further research to identify and develop a catheter device material that will reduce the incidence for CAUTIs.

Keywords: Antibiotic resistance; CAUTI; Nosocomial infection; Silver-alloy; UTI; Urinary catheter; Urology.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses workflow for article identification

Fig. 2

Forest plot of risk (reporting odds ratio (OR) and 95% confidence interval (CI)) of developing UTI between patients using new silver-based antimicrobial catheters against standard catheters

Fig. 3

Pooled odds ratios (ORs) and 95% confidence interval (CIs) of developing UTI between patients using new silver-based antimicrobial catheters against standard catheters grouped according to new silver-based catheter material characteristics

Fig. 4

Forest plot of risk (reporting odds ratio (OR) and 95% confidence interval (CI)) of developing UTI between patients using new non-silver-based antimicrobial catheters against standard catheters

Fig. 5

Pooled odds ratios (ORs) and 95% confidence interval (CIs) of developing UTI between patients using new non-silver-based antimicrobial catheters against standard catheters grouped according to new antimicrobial catheter material characteristics

Fig. 6

Micro-organism genus involved in CAUTI identified in included studies