Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteriuria: A prospective, randomized, multicenter clinical trial

Objectives. To examine the efficacy of bladder catheters impregnated with m inocycline and rifampin in reducing catheter-associated bacteriuria. Method s. A prospective, randomized clinical trial was conducted at five academic medical centers. Patients undergoing radical prostatectomy were randomized to receive intraoperatively either regular silicone bladder catheters (cont rol catheters) or silicone bladder catheters impregnated with minocycline a nd rifampin (antimicrobial-impregnated catheters). Catheters remained in pl ace for a mean of 2 weeks. Urine cultures were obtained at about 3, 7, and 14 days after catheter insertion. Bacteriuria was defined as the growth of organism(s) in urine at a concentration of 10(4) colony-forming units per m illiliter or greater. Results. Kaplan-Meier analysis demonstrated that it t ook significantly longer for patients (n = 56) who received the antimicrobi al-impregnated catheters to develop bacteriuria than those (n = 68) who rec eived the control catheters (P = 0.006 by the log-rank test). Patients who received the antimicrobial-impregnated catheters had significantly lower ra tes of bacteriuria than those in the control group both at day 7 (15.2% ver sus 39.7%) and at day 14 (58.5% versus 85.5%) after catheter insertion, Pat ients who received the antimicrobial-impregnated catheters had significantl y lower rates of gram-positive bacteriuria than the control group (7.1% ver sus 38.2%; P < 0.001) but similar rates of gram-negative bacteriuria (46.4% versus 47.1%) and candiduria (3.6% versus 2.9%). The antimicrobial-impregn ated catheters provided zones of inhibition against Enterococcus faecalis a nd Escherichia coli, both at baseline and on removal. Conclusions. Bladder catheters impregnated with minocycline and rifampin significantly reduced t he rate of gram-positive catheter-associated bacteriuria up to 2 weeks afte r catheter insertion. (C) 1999, Elsevier Science Inc.