Gauhar Vineet, Castellani Daniele, Teoh Jeremy Yuen-Chun, Nedbal Carlotta, Chiacchio Giuseppe, Gabrielson Andrew T, Heldwein Flavio Lobo, Wroclawski Marcelo Langer, de la Rosette Jean, Donalisio da Silva Rodrigo, Galosi Andrea Benedetto, Somani Bhaskar Kumar
Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore 609606, Singapore.
Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, 60126 Ancona, Italy.
J Clin Med. 2022 Jul 30;11(15):4463. doi: 10.3390/jcm11154463.
Coated urethral catheters were introduced in clinical practice to reduce the risk of catheter-acquired urinary tract infection (CAUTI). We aimed to systematically review the incidence of CAUTI and adverse effects in randomized clinical trials of patients requiring indwelling bladder catheterization by comparing coated vs. non-coated catheters. This review was performed according to the 2020 PRISMA framework. The incidence of CAUTI and catheter-related adverse events was evaluated using the Cochran−Mantel−Haenszel method with a random-effects model and reported as the risk ratio (RR), 95% CI, and p-values. Significance was set at p < 0.05 and a 95% CI. Twelve studies including 36,783 patients were included for meta-analysis. There was no significant difference in the CAUTI rate between coated and non-coated catheters (RR 0.87 95% CI 0.75−1.00, p = 0.06). Subgroup analysis demonstrated that the risk of CAUTI was significantly lower in the coated group compared with the non-coated group among patients requiring long-term catheterization (>14 days) (RR 0.82 95% CI 0.68−0.99, p = 0.04). There was no difference between the two groups in the incidence of the need for catheter exchange or the incidence of lower urinary tract symptoms after catheter removal. The benefit of coated catheters in reducing CAUTI risk among patients requiring long-term catheterization should be balanced against the increased direct costs to health care systems when compared to non-coated catheters.
带涂层的尿道导管被引入临床实践，以降低导管相关性尿路感染（CAUTI）的风险。我们旨在通过比较带涂层导管和无涂层导管，系统回顾需要留置膀胱导管的患者在随机临床试验中CAUTI的发生率和不良反应。本综述按照2020年PRISMA框架进行。使用Cochran-Mantel-Haenszel方法和随机效应模型评估CAUTI的发生率和导管相关不良事件，并报告为风险比（RR）、95%置信区间（CI）和p值。显著性设定为p<0.05和95%CI。纳入12项研究，共36783例患者进行荟萃分析。带涂层导管和无涂层导管的CAUTI发生率无显著差异（RR 0.87，95%CI 0.75-1.00，p=0.06）。亚组分析表明，在需要长期导管插入（>14天）的患者中，带涂层组的CAUTI风险显著低于无涂层组（RR 0.82，95%CI 0.68-0.99，p=0.04）。两组在导管更换需求发生率或拔管后下尿路症状发生率方面无差异。与无涂层导管相比，带涂层导管在降低长期导管插入患者CAUTI风险方面的益处，应与医疗保健系统增加的直接成本相权衡。
