***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Indwelling urinary catheters are the leading source of nosocomial urinary tract infections ( NUTIs ) . The Bardex I.C. catheter is a hydrogel latex Foley catheter with a monolayer of silver metal applied to the inner and outer surfaces of the catheter . We investigated the Bardex I.C. catheter for its ability to decrease the NUTI rate in critical care units . METHODS Five hospitals participated in a blind prospect i ve study , exchanging the st and ard latex Foley catheter for the Bardex I.C. Foley catheter . The device use rate and NUTI rate were monitored . Data were collected and analyzed using Wilcoxon rank sum test and four-way analysis of variance . A cost analysis was also performed . RESULTS The baseline period , intervention period , and number of device days was similar for both periods . The unadjusted catheter-associated infection rate during the baseline and intervention periods was 7.1 and 4.5 infections per 1000 catheter days , respectively ( P < 0.01 ) . The adjusted catheter-associated infection rate during the baseline and intervention periods was 8.1 and 4.9 infections per 1000 catheter days , respectively . This was not statistically significant ( P = 0 . 13 ) . CONCLUSIONS A trend toward a reduction in NUTIs with the use of the hydrogel/silver-coated catheter was noted in all intensive care units at each institution as shown by the unadjusted and adjusted catheter-associated infection rates . One hospital demonstrated a statistically significant reduction in NUTIs . However , statistical significance was not met when the results were adjusted . The cost analysis at one institution demonstrated cost savings with the use of the silver-coated catheter . Future analysis may require a double-blind , prospect ive-controlled study of longer duration to reach statistical significance A controlled r and omised prospect i ve study has been carried out on 100 male patients to compare the incidence of urethritis following catheterisation with either latex or silicone catheters .  All patients underwent elective cardiac surgery and were catheterised for 48 h with antibiotic cover , and were followed up for 6 months post-operatively . Of those with latex catheters 22 % developed urethritis , compared with 2 % of those in the silicone catheter group . This difference is statistically significant ( P less than 0.01 ) . Two of the former patients developed a decreased urinary flow and both had tight anterior urethral strictures The tendency to develop bacteriuria during the use of various forms of indwelling catheters was evaluated in a r and omized trial in 90 patients . A silver alloy and hydrogel-coated Foley catheter ( SHC ) was compared to a non-coated catheter ( NC ) and a catheter coated only with hydrogel ( HC ) . Three patients ( 10 % ) with SHC catheters , 10 ( 33 % ) patients with HC catheters , and 15 ( 50 % ) patients with NC catheters developed bacteriuria ( greater than 10(5 ) organisms/ml ) . The difference in the rate of bacteriuria after 5 days of catheterization was statistically significant between the SHC catheter and the NC catheter ( p less than 0.002 ) . There was no significant difference between the SHC catheter and the HC catheter , nor was there a significant difference between the HC catheter and the NC catheter . The toxic effects , as estimated by the IC50 value , of the urinary catheter material used was eluci date d in an experimental fibroblast model . The IC50 value for the NC catheter was 33.9 % , HC catheter 72.2 % and for the SHC catheter 98.1 % Thirty-eight patients with problems with their urinary catheters were r and omly treated with Varidase ® or normal saline solution once a day for 10 days . Photographs were taken by using a cystoscope before treatment , at day 10 and day 24 after the commencement of treatment . The photographs were evaluated according to the occurrence of pus , debris , coagula and rubor . In the Varidase ® group the improvements from baseline to day 10 and day 24 were statistically significant ( p < 0·05 ) in all parameters while there were no statistically significant improvements in the saline group . Comparing the two treatment groups , regarding the changes from baseline to day 10 and day 24 , it was statistically demonstrated that Varidase ® was significantly more effective than saline in all parameters ( p < 0·05 ) . In conclusion , this study shows that Varidase ® effectively cleans the urinary bladder from pus , fibrin , necrotic tissue and blood clots Context Indwelling urinary catheters increase risk for bacteriuria and clinical ly significant  urinary tract infection . Contribution In this r and omized trial , trauma patients who received a catheter impregnated with nitrofurazone  were less likely to have bacteriuria and funguria than were those who received a st and ard silicone catheter .  They were also less likely to need a change in antibiotic or addition of new antibiotics . Caution Data on outcomes were missing for many patients . Implication By reducing the incidence of bacteriuria and funguria , nitrofurazone-impregnated urinary catheters appear to reduce the need to change or prescribe new antimicrobial therapy in patients who require indwelling catheters . The Editors Urinary tract infection ( UTI ) is one of the most common nosocomial infections in hospitalized patients and is most often associated with an indwelling catheter ( 1 ) . The leading risk factor for bacteriuria is the duration of catheterization : With each day of catheterization , the prevalence of bacteriuria increases 3 % to 10 % ( 2 ) . Trauma patients are prone to infectious complications ( 3 , 4 ) , in part as a result of invasive devices in supportive therapy . Urinary catheters are often needed in the trauma care setting , and UTI accounts for 24 % of nosocomial infections ( 5 ) . Urinary tract infection is the focus for sepsis in 6 % to 8 % of injured patients ( 6 ) , and sepsis is associated with increased mortality ( 7 ) . The best preventive measure for catheter-associated UTI is to minimize the use of indwelling catheters and to remove catheters as soon as possible . However , other approaches to reduce catheter-associated UTI are required . One possibility is to incorporate antibacterial agents , such as nitrofurazone , in the catheter material . Doing so may prevent migration of bacteria , colonization of the catheter , and formation of biofilm . Like nitrofurantoin , nitrofurazone is a nitrofuran and has been used for more than 50 years without any sign of microbial resistance ( 8 , 9 ) . In vitro studies have shown that nitrofurazone-impregnated catheters inhibited the growth of 75 % of common urinary bacterial isolates ( 10 ) and of several multidrug-resistant isolates ( 11 ) . We design ed a r and omized , double-blind , controlled clinical trial to test the hypothesis that nitrofurazone-impregnated urinary catheters could reduce the incidence of catheter-associated UTI in adult trauma patients compared with st and ard silicone catheters . Methods Design We conducted a r and omized , double-blind , controlled trial comparing a nitrofurazone-impregnated urinary catheter ( Releen NF , Coloplast A/S , Humlebaek , Denmark ) with a st and ard silicone urinary catheter ( Simpla All Silicone , Coloplast A/S ) in trauma patients . Setting and Participants During a 24-month period ( July 2003 to August 2005 ) , we included all consecutive adult ( age 18 years ) trauma patients who needed a urinary catheter and were admitted directly from the accident scene to the Trauma Center in Copenhagen , Denmark . Exclusion criteria were HIV infection ; preinjury treatment with corticosteroids ; pregnancy ; primary burn injury ; and unattainable signed informed consent . The Trauma Center in Copenhagen is a level 1 trauma center at a tertiary university hospital . After the trauma resuscitation phase , patients were transferred to an intensive care unit or a surgical ward . On arrival , prophylactic antibiotics were given according to the site and type of injury . Antibiotics were not given for minor injuries . For closed injuries , intravenous cefuroxime , 1.5 g 3 times daily , was given for up to 3 days ; for open injuries , intravenous ceftriaxone , 2 g twice a day for up to 3 days , combined with metronidazole , 500 mg 3 times daily , was given . This regimen was continued regardless of which ward or intensive care unit the patient was admitted to . The local ethics committee and the Danish Data Protection Agency approved the study , and written informed consent was obtained from the patients or next of kin . The study was performed in accordance with the 1975 Declaration of Helsinki , as revised in 1983 . R and omization and Interventions The r and omization list was computer-generated , with a block size of 8 ( Medstat , version 2.1 ; ASTRA Group A/S , Albertslund , Denmark ) , by a biostatistician who was independent of the investigators . The trauma team leader enrolled patients ; at enrollment , allocation to treatment groups was concealed . Two nurses from a team of nurses specially trained in the allocation and catheterization procedure performed the allocation by sequentially opening consecutively numbered , sealed r and omization envelopes that contained the name of the assigned catheter . Catheterizing nurses were not formally blinded to catheter type , but both study catheters were new in the hospital . Thus , nurses caring for the patients did not know which of the new catheters was the nitrofurazone catheter . Patients were effectively blinded to their catheter assignment because 1 ) the catheter package was opened outside the patients ' field of vision ; 2 ) the patients could not see the catheter at the time of insertion because their necks were immobilized ( 12 ) ; and 3 ) although the catheters differed only in color , patients were not informed of the name or type of the catheter used . All catheterizations were performed according to st and ard hospital guidelines . The patient 's genitals were washed with water and soap ( Cutan Skin Care System , DEB , Belper , United Kingdom ) , sterile gloves and aseptic insertion technique were used , sterile antiseptic gel ( Instillagel [ lidocaine 2 % , chlorhexidine 0.25 % ] , Farco-Pharma , Kln , Germany ) was inserted into the urethra , and isotonic sodium chloride was used to fill the balloon . Finally , the catheter was connected to a urine bag with an antireflux valve ( UnoMeter , Unomedical A/S , Birkeroed , Denmark ) forming the closed drainage system . Adhesive tape was used to assess whether the system had remained unbroken . The size of the catheter used was determined by clinical evaluation ; catheters were available in sizes 12 to 16 French . Catheters were removed at the treating physician 's discretion as soon as permitted by the patient 's condition . Outcomes and Follow-up The primary outcome variable was the incidence of catheter-associated bacteriuria and funguria ( CABF ) , defined a priori as bacteriuria or funguria with at least 103 colony-forming units (CFU)/mL for at least 1 isolate , regardless of whether the patients experienced symptoms . The primary outcome variable was chosen as a surrogate end point for catheter-associated UTI . In addition , a post hoc analysis was done with CABF defined as at least 105 CFU/mL. A urine sample for culture was taken immediately after catheter insertion and then daily until the catheter was removed . Aseptic 5-mL urine sample s were taken by syringe aspiration from the sampling port without violating the closed drainage system . Sample s were immediately refrigerated at 4 C and were subsequently transferred to the laboratory as quickly as possible . On arrival in the laboratory , 1 L and 10 L of urine were cultivated on 5 % horse blood agar plates and on McCoy agar plates ( Statens Serum Institut , Copenhagen , Denmark ) for the culture quantitative analysis . The procedure is st and ard at the laboratory , and the technicians were blinded to the type of catheter used . After incubation at 37 C , the plates were inspected for growth and the number of CFU was calculated . Bacteria and fungi were identified by the automatic ATB Expression using the API identification system ( bioMrieux , Marcy l'toile , France ) . Antibiotic sensitivity testing was performed by using Neo-sensitab ( Rosco A/S , Taastrup , Denmark ) . The microbiologist evaluating the urine cultures was blinded to the type of catheter used . Blinded data were entered into the electronic data base at the Department of Clinical Microbiology , and the treating physician was informed of the culture results . Decisions regarding antimicrobial therapy were at the treating physician 's discretion . All patients were assessed daily by the investigators to ensure correct catheter assignment in enrolled patients , to ascertain whether enrolled patients still had the study catheter in place , and to determine whether the closed system had remained unbroken . If the closed system had been violated or the study catheter had been removed , results from subsequent urine sample s were not included in the final analysis . In addition , demographic characteristics , clinical variables , Injury Severity Score ( ISS ) , and 30 
    Output:
    
The results suggest that the use of silver alloy indwelling catheters for catheterising hospitalised adults short-term reduces the risk of catheter acquired urinary tract infection .
Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters .
There was not enough evidence to suggest whether or not any st and ard catheter was better than another in terms of reducing the risk of urinary tract infection in hospitalised adults catheterised short-term .