Study objectives: 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.
Design: Prospective, nonrandomized, controlled trial.
Setting: Medical/surgical/trauma ICU in a university
Patients: Two hundred twenty-four ICU
patients requiring an indwelling urinary catheter.
Intervention: 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.
Measurements and 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 (α = 0.05). The higher cost of a CCDS is not justified
for ICU patients.