***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 % During a 23-month study , we identified 1,233 patients with nosocomial urinary tract infections ( UTIs ) among 40,718 consecutive admissions by using a st and ardized , prospect i ve system of hospital-wide surveillance .  Nosocomial bloodstream infections ( BSIs ) occurred in 565 patients , 32 of whom had BSIs originating from UTIs , for an attack rate of 2.7 per 100 patients with nosocomial bacteriuria . Patients with UTIs due to Serratia marcescens were most likely to develop secondary BSIs ( rate , 16 per 100 ) compared to patients with nosocomial UTIs due to other organisms ( rate , less than or equal to 4.3 per 100 ; P less than 0.05 ) . Furthermore , the median interval between documentation of UTI and of secondary BSI was 24 days for patients with infections due to S marcescens compared to one day for the entire group ( P less than 0.005 ) . Risk factor analysis indicated that men with UTIs were more likely to develop secondary BSIs than were women ( P less than 0.05 ) . Intensified infection control efforts are particularly necessary with high-risk groups such as bacteriuric men -- especially among those patients with UTIs due to S marcescens -- to reduce the incidence of secondary , hospital-acquired BSIs Because latex rubber catheters have been implicated in urethral stricture formation , the incidence of urethral strictures following  transurethral prostatectomy ( TUP ) and subsequent catheterisation with latex rubber or polyvinyl chloride catheters was compared . A total of 84 patients with benign prostatic hyperplasia ( n = 71 ) or prostatic carcinoma ( n = 13 ) underwent assessment of urethral diameter and subsequent internal urethrotomy prior to TUP . Following resection , 42 patients received three-way self-retaining latex rubber catheters and 42 received similar catheters made of PVC . Catheters were removed when the urine was clear ( mean time = 3 days ) , and no patient required recatheterisation . Urinary flow was assessed in all patients at 6 , 12 and 24 weeks after surgery , and diminution of flow with submeatal stricture formation was noted in one patient who had received a latex rubber catheter , and in one who had received a PVC catheter . In this study , the composition of the catheter had no bearing on subsequent stricture formation following TUP Objective To determine the effect on the occurrence of urosepsis  of a treatment with a short course of antibiotics and indwelling urethral catheter replacement in clinical ly asymptomatic intensive care unit ( ICU ) patients with a positive urine culture occurring at least 48 h after catheterization . Methods A prospect i ve r and omized clinical trial was conducted in the medico-surgical ICU of a tertiary care centre . Sixty patients hospitalized in the ICU with an indwelling urethral catheter for longer than 48 h developing an asymptomatic positive urine culture were r and omized to receive either a 3-day course of antibiotics associated with the replacement of the indwelling urethral catheter 4 h after first antibiotic administration or no antibiotics , no catheter replacement ( st and ard of care ) . Results Three patients in each group developed urosepsis ( P = 0.1 ) . There were no significant differences in duration of mechanical ventilation between the study group and the st and ard of care group ( 9 [ 4–20 ] days vs 5 [ 2–15 ] days , P = 0.2 ) , in duration of urinary catheterization ( 22 [ 11–40 ] days vs 18 [ 14–33 ] days , P = 0.8 ) , or in length of ICU stay ( 28 [ 13–46 ] vs 19 [ 15–34 ] , P = 0.6 ) . The recurrence of positive urine culture at days 7 and 15 was not affected by the r and omization ( P = 0.1 ) . The profile of bacterial resistance was similar in the two groups . Conclusions Treating a positive urine culture in an asymptomatic patient with an indwelling urethral catheter does not reduce the occurrence of urosepsis in the medico-surgical ICU 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 Intermittent catheterization is now the preferred method for urethral catheterization of the urinary bladder when an indwelling catheter is not required . Nevertheless , the procedure may cause discomfort or pain . This r and omized , prospect i ve study was done to compare patient-perceived discomfort between two commonly used hydrophilic , single-use catheters in women . A total of 196 women referred to the urogynaecology section in the outpatient department were r and omized to be catheterized with either a LoFric ( n=102 ) or a SpeediCath ( n=94 ) catheter . Both catheters are hydrophilic , low friction , single-use , disposable catheters . Discomfort was measured using a visual analogue scale ( VAS ) . The results showed no difference in degree of patient-perceived discomfort between the two groups . Median score was 0.75 VAS points in both groups , which indicates little discomfort . Half of all the patients stated that they experienced no discomfort at all 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 . 
    Output:
    
The results of this trial showed less bacteriuria in the silver alloy catheter group .
For the outcome of urethral reactions , fully siliconised catheters appeared to be superior to latex-based catheters .
There were no statistically significant differences between the different catheters for all other outcomes .
Silver alloy-coated catheters were not associated with a statistically significant reduction in symptomatic CAUTI , and are considerably more expensive .
Nitrofurazone-impregnated catheters reduced the risk of symptomatic CAUTI and bacteriuria , although the magnitude of reduction was low and hence may not be clinical ly important .
However , they are more expensive than st and ard catheters .
They are also more likely to cause discomfort than st and ard catheters