Silver alloy vs. uncoated urinary catheters: a systematic review of the literature

Aims and objectives. This systematic review aimed to determine whether there was enough evidence to conclude that silver-alloy urinary catheters reduce catheter-associated urinary tract infections compared with silicone or latex urinary catheters in adult inpatients. Background. Previous systematic reviews into the effectiveness of silver-coated urinary catheters have offered limited opportunity to transfer their findings into practice. These studies have been on North American products only, of generally poor quality, or several years since their completion (Brosnahan J, Jull A & Tracy C 2004, Cochrane Database Systematic Reviews, Issue 1, Art. No.: CD004013). Design. A systematic review of the literature was deemed the most appropriate research method to apply as there had already been several studies (Saint S, Veenstra DL, Sullivan SD, Chenoweth C & Fendrick AM 2000, Archives of International Medicine, 160, 2670–2675; Lai KK & Fontecchio SA 2002, American Journal of Infection Control, 30, 221–225; Schaeffer AJ 2005, The Journal of Urology, 173, 845–846) relating to the subject in question, although there were some queries regarding their methodological rigour. Methods. Randomised control trials, systematic reviews and meta-analyses were identified by searching relevant databases. Relevant papers were judged against predefined inclusion and exclusion criteria. Ten per cent of papers were assessed by a second reviewer. Following the application of a numerical filtering tool, six papers were rejected and eleven papers were retained. Results. Of the 11 papers retained, there were eight studies, as some studies published more than one paper. The integrated results did present a consistent pattern favourable towards the efficacy of silver-alloy urinary catheters to reduce catheter-associated urinary tract infection. Conclusion. The collective evidence divulged an emerging pattern favouring the efficacy of silver-alloy urinary catheters to reduce catheter-associated urinary tract infection. Owing to the poor quality of some individual studies included in other systematic reviews and the inability to carry out meta-analysis because of significant heterogeneity, definitive conclusions cannot be drawn from the study. Relevance to clinical practice. Given the significant prevalence of catheter-associated urinary tract infection, early indications of improved infection rate outcomes using silver-alloy urinary catheters should not be dismissed