chapter  18
44 Pages

Antimicrobial Urinary Catheters

WithDavid J. Stickler, Nora A. Sabbuba

CONTENTS 18.1 Introduction ........................................................................................... 415 18.2 Uses and Prevalence of Urinary Catheters....................................... 416 18.3 Catheter-Associated Urinary Tract Infections.................................. 417 18.4 Complications of Catheter-Associated UTI ...................................... 420 18.5 Attempts to Control Catheter-Associated UTI ................................ 421 18.6 Silver Catheters ..................................................................................... 424 18.7 Minocycline-and Rifampicin-Impregnated Catheters ................... 430 18.8 Nitrofurazone Catheters ...................................................................... 431 18.9 General Conclusions on Clinical Trials on Catheters ..................... 434 18.10 Antimicrobial Catheters Yet to Be Tested in Clinical Trials.......... 436 18.11 The Catheter Encrustation Problem .................................................. 442 18.12 Conclusions............................................................................................ 449 References ........................................................................................................... 450

Indwelling bladder catheters are the most commonly deployed prosthetic medical devices [1]. It is estimated that worldwide over 100 million are used annually. They have many applications in modern medicine. In acute care in hospitals, they have important roles monitoring and controlling urine production from unconscious patients, and facilitating repair of the urethra after surgical procedures such as prostatectomy. In chronic care, they are used for the long-term management of urinary retention and incontinence in the elderly and in patients disabled by strokes, spinal injury, or neuropathies such as multiple sclerosis. While these devices perform essential functions, unfortunately they also pose serious threats to the health and welfare of many patients. As long ago as 1958, Paul Beeson was warning of the dangers of indwelling bladder catheterization [2]. In his famous editorial

‘‘The Case against the Catheter’’ he concluded that ‘‘. . .the decision to use this instrument should be made with the knowledge that it involves the risk of producing a serious disease which is often difficult to treat.’’ These warnings were echoed some 30 years later when Calvin Kunin made the point that it is really quite extraordinary that although sophisticated technological advances have been made in the development of prosthetic devices in many other areas of medicine, we are still not able to perform the apparently simple task of draining the urine from patient’s bladders without putting them at risk of serious illness [3]. The catheters that are used in such large numbers today have changed little in design from the devices introduced into urological practice by Dr. Fredrick Foley in the 1930s.