Reducing urine infections: a new study to examine the benefits of using antibiotic or antiseptic treated catheters

About one in four patients in hospital need a urinary catheter for a short while. This may cause a urine infection in about 7% of them, amounting to about 30,000 patients over the course of a year in the UK. These infections are important because the slow the patient's recovery from illness or surgery and can lead to serious consequences such as bloodstream infections.

The NHS has a target to reduce such infections by 15%. This is hard to achieve however, as catheters easily become contaminated with bacteria from the patient's own skin or bowel. For every day that the catheter is left in, bacteria colonise the urine in about 5% of patients. Simple measures such as general hygiene and removing catheters as soon as possible help to reduce the overall risk if developing a urine infection.

Recently it has been shown that catheters containing antibiotics or antiseptics such as silver reduce colonisation by bacteria and lessen the risk of infection. But these catheters are expensive, and it is not clear how much they benefit individual patients and whether the increased costs are matched by better health.

Now however, thanks to a grant of £1.4 million from the NHS research funding body Health Technology Assessment, the urology research team of the University of Aberdeen and NHS Grampian will lead a major, multi-centre trial involving several large hospitals which provide acute medical and surgical care, to investigate the benefits of using these 'treated' catheters.

The team will compare the use of standard catheters with those containing antibiotics or antiseptics in patients who only need a catheter for a short time (less than two weeks). Patients who need a catheter as part of their routine care will be randomly allocated to have either a standard or treated catheter. They will then be asked to fill in questionnaires in hospital, and after they go home, to find out whether a urine infection occurred, and if this affected their health, treatment, or hospital stay. The costs and benefits of each type of catheter can then be compared to see whether one is better than another for routine use in the NHS. We will also study patients who are especially vulnerable to severe infection, such as the elderly and those in intensive care, to see whether treated catheters might particularly benefit them.

To lead this trial, the Aberdeen experts have assembled a team of clinicians, researchers and health economists who have wide experience in this field. The results of this study will allow the NHS to decide whether, for short-term use, catheters containing antibiotics or antiseptics (rather than standard untreated catheters) will reduce infections, be cost-effective, and result in better patient health.