title: Prevention of nosocomial urinary tract infection in ICU patients: comparison of effectiveness of two urinary drainage systems.
abstract: OBJECTIVE
  To determine whether the rate of acquisition of bacteriuria differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients.
  
  
  METHODS
  Prospective, nonrandomized, controlled trial.
  
  
  METHODS
  Medical/surgical/trauma ICU in a university hospital.
  
  
  METHODS
  Two hundred twenty-four ICU patients requiring an indwelling urinary catheter.
  
  
  METHODS
  We compared the rate of acquisition of bacteriuria in two groups of consecutive patients (n = 113 and n = 111, respectively) who underwent bladder catheterization with a TCOS during the first 6 months and with a CCDS during the next 6 months. Urinary catheters were managed by a team of trained nurses following the same written protocol. No prophylactic antibiotics were administered, either during management of catheter placements or catheter withdrawal, but 75% of patients received one or more antimicrobial medications for treatment of infected sites other than the urinary tract. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. Only patients who required an indwelling catheter for > 48 h were evaluated.
  
  
  RESULTS
  There was no statistical difference in the rate of bacteriuria between the two groups. Bacteriuria occurred in 11.5% and 13.5% of patients, and was diagnosed on day 14 +/- 8 and 13 +/- 9 of catheterization (mean +/- SD) for the TCOS and the CCDS, respectively. A CCDS cost $3 (US dollars) more than the TCOS.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to compare the effectiveness of a TCOS and a CCDS in ICU patients. No differences were noted between the two systems (alpha = 0.05). The higher cost of a CCDS is not justified for ICU patients.
authors.affiliation: Intensive Care Unit and Trauma Center, Nord Hospital, Marseilles University Hospital System, Marseilles School of Medicine, Marseilles, France. mleone@mail.ap-hm.fr
authors.forename: M
authors.initials: M
authors.lastname: Leone
authors.forename: F
authors.initials: F
authors.lastname: Garnier
authors.forename: M
authors.initials: M
authors.lastname: Dubuc
authors.forename: M C
authors.initials: MC
authors.lastname: Bimar
authors.forename: C
authors.initials: C
authors.lastname: Martin
mesh_terms: D001437:Bacteriuria / Q000382:microbiology / Q000517:prevention & control; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014546:Urinary Catheterization / Q000295:instrumentation*; D014552:Urinary Tract Infections / Q000517:prevention & control*