title: A large randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection.
abstract: OBJECTIVE
  The antibacterial activity of silver-containing compounds has recently been employed in constructing medical devices, such as vascular and urinary catheters, that may be effective in blocking infection. The present study was designed to evaluate the efficacy of a silver oxide-coated urinary catheter.
  
  
  METHODS
  A total of 1,309 hospitalized patients who required placement of an indwelling urinary catheter for 24 hours or longer were randomly assigned to receive either a silicone catheter coated externally with 5% silver oxide or a standard silicone elastomer-coated latex catheter. Daily catheter-urine specimens were collected aseptically and catheter-care violations were monitored daily for the duration of the catheterization.
  
  
  RESULTS
  Bacteriuria developed in 85 of 745 patients (11.4%) in the silver-coated catheter group and in 73 of 564 patients (12.9%) in the control group (P = 0.45). In women who did not receive antibiotics, the rates were 29.3% and 30.4%, respectively (P = 0.98). In men who did not receive antibiotics, the rate of bacteriuria was significantly higher with the silver-coated catheter (29.4% compared to 8.3%, respectively, P = 0.02). Staphylococcal species were isolated more often from the silver-coated catheter group than from the control group (25% versus 8% of all isolates, respectively, P = 0.002).
  
  
  CONCLUSIONS
  This study, the largest ever reported evaluating any silver-impregnated device, has not only failed to demonstrate the efficacy of silver in prevention of catheter-associated bacteriuria, as suggested in prior studies, but it has also shown a significantly increased incidence of bacteriuria in male patients and a significantly increased occurrence of staphylococcal bacteriuria. These results suggest the need for caution and for similar large-scale trials before silver-containing compounds are widely used for preventing device-associated infections, both in vascular and urinary catheters.
authors.affiliation: Division of Infectious Diseases, LDS Hospital, Salt Lake City, Utah 84143, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Riley
authors.forename: D C
authors.initials: DC
authors.lastname: Classen
authors.forename: L E
authors.initials: LE
authors.lastname: Stevens
authors.forename: J P
authors.initials: JP
authors.lastname: Burke
mesh_terms: D001437:Bacteriuria / Q000209:etiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use*; D012307:Risk Factors; D018030:Silver Compounds / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000209:etiology*; D015163:Superinfection / Q000209:etiology*; D017211:Treatment Failure; D014546:Urinary Catheterization / Q000009:adverse effects*
chemical_list: D010087:Oxides; D018030:Silver Compounds; C040225:disilver oxide