title: Daily meatal care for prevention of catheter-associated bacteriuria: results using frequent applications of polyantibiotic cream.
abstract: OBJECTIVE
  To determine the efficacy of meatal treatment with a polyantibiotic cream in the prevention of bacteriuria during transurethral bladder catheterization.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Community teaching hospital.
  
  
  METHODS
  Adult patients who underwent closed urinary catheter drainage for short and intermediate durations (two to 30 days).
  
  
  METHODS
  Polyantibiotic cream containing polymyxin B sulfate, neomycin sulfate, and gramicidin was applied to the urethral meatus-catheter interface three times daily from the first day of catheterization until bacteriuria was found. The onset of bacteriuria was defined as the day the colonizing species first achieved a colony count of greater than or equal to 1000 colonies/ml. Patients randomized to the control group received routine meatal care with cleansing of the meatal surface during daily bathing.
  
  
  RESULTS
  Among 2,923 patients who were randomly allocated to receive either the protocol meatal care or routine care, the evaluable study population consisted of 747 patients who were nonbacteriuric and who remained catheterized for more than two days. Overall, 26 (6.8%) of 383 patients given the polyantibiotic treatment acquired bacteriuria, as compared to 37 (10.1%) of 364 patients not given this treatment (p = .167). A Cox proportional hazards regression analysis showed that, among putative risk factors including lack of meatal care, only female gender, a meatal swab culture yielding gram-negative rods or enterococci, and lack of antibiotic use during catheterization were independently associated with the development of bacteriuria.
  
  
  CONCLUSIONS
  The adverse effect of meatal care noted in earlier studies of a disinfectant ointment applied twice daily was not found in this study of an antimicrobial preparation in a cream vehicle applied three times daily. However, the results do not support meatal care as an efficacious method to prevent catheter-associated bacteriuria in all patients.
authors.affiliation: Department of Medicine, LDS Hospital, Salt Lake City, UT 84143.
authors.forename: D C
authors.initials: DC
authors.lastname: Classen
authors.forename: R A
authors.initials: RA
authors.lastname: Larsen
authors.forename: J P
authors.initials: JP
authors.lastname: Burke
authors.forename: D W
authors.initials: DW
authors.lastname: Alling
authors.forename: L E
authors.initials: LE
authors.lastname: Stevens
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D001437:Bacteriuria / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments; D014521:Urethra / Q000382:microbiology*; D014546:Urinary Catheterization / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D009824:Ointments