***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 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 We evaluated short-term systemic antimicrobial prophylaxis for catheter-associated bacteriuria in women undergoing elective gynecological operations in a prospect i ve , controlled , double-masked study . Nine of 100 placebo-treated patients acquired bacteriuria during catheterization compared with 3 of 96 of the drug-treated group . However , at the time of hospital discharge , clean-voided urine specimens were positive as frequently in the drug-treated group ( 8 of 82 patients cultured ) as in the placebo group ( 8 of 75 patients cultured ) . No difference in febrile morbidity due to bacteriuria was noted between the prophylaxis and placebo groups . The incidence of catheter-associated bacteriuria may be reduced by antimicrobial prophylaxis . However , because the protective effect is transient and is associated with the selection of resistant organisms , prophylaxis is not indicated for patients at low risk for acquired bacteriuria and in whom the sequelae of catheter-associated infections are infrequent BACKGROUND Urinary tract infections ( UTIs ) account for 30 % to 40 % of nosocomial infections result ing in morbidity , mortality , and increased length of hospital stay . OBJECTIVE To assess the efficacy of a silver-alloy , hydrogel-coated latex urinary catheter for the prevention of nosocomial catheter-associated UTIs . METHODS A 12-month r and omized crossover trial compared rates of nosocomial catheter-associated UTI in patients with silver-coated and uncoated catheters .  A cost analysis was conducted . RESULTS There were 343 infections among 27,878 patients ( 1.23 infections per 100 patients ) during 114,368 patient-days ( 3.00 infections per 1000 patient-days ) . The relative risk of infection per 1000 patient-days was 0.79 ( 95 % confidence interval , 0.63 - 0.99 ; P = .04 ) for study wards r and omized to silver-coated catheters compared with those r and omized to uncoated catheters . Infections occurred in 291 of 11,032 catheters used on study units ( 2.64 infections per 100 catheters ) . The relative risk of infection per 100 silver-coated catheters used on study wards compared with uncoated catheters was 0.68 ( 95 % confidence interval , 0.54 - 0.86 ; P = .001 ) . Fourteen catheter-associated UTIs ( 4.1 % ) were complicated by secondary bloodstream infection . One death appeared related to the secondary infection . Estimated hospital cost savings with the use of the silver-coated catheters ranged from $ 14,456 to $ 573,293 . CONCLUSIONS The risk of infection declined by 21 % among study wards r and omized to silver-coated catheters and by 32 % among patients in whom silver-coated catheters were used on the wards . Use of the more expensive silver-coated catheter appeared to offer cost savings by preventing excess hospital costs from nosocomial UTI associated with catheter use . Arch Intern Med . 2000;160:3294 - 3298 Summary A catheter was design ed to decrease the incidence of catheter-induced urinary infections . A r and omized , controlled study was performed to assess its safety and efficacy . The study comprised 24 patients subjected to hemorrhoidectomy . The criteria for entry were a preoperative urinary pathogen count below 105 colony-forming units/ml urine as well as postoperative urinary retention that did not respond to conservative measures . The 24 patients were r and omly assigned to treatment using a Nelaton catheter in 12 patients and an electrified catheter in the remaining 12 . The catheters were left in place for 3 days , during which cephalosporin was given parenterally . The electrified catheter ( EC ) carried two silver-silver chloride electrodes . During the 3 days of catheterization and for 4 days thereafter , daily urine sample s were cultured . The criterion for catheter-induced urinary infection was a pathogen count above 105 colony-forming units/ml urine . No complication was encountered from catheterization . Electrodes were not broken . A bacterial count above 105 colony-forming units was found in 7 of 12 patients in the Nelaton catheter group , and a count below 105 units was determined in the 12 patients in the EC group . The study demonstrated that the EC can decrease the incidence of catheter-induced urinary infections . The EC is safe , cost-effective , and without complications Indwelling urinary catheter may induce an inflammatory reaction or even stricture of the urethra . Catheter encrustation and urinary infection are other disadvantages associated with long-term catheterisation . In the present study , 77 male patients were catheterised r and omly as part of their normal treatment with 1 of 3 different types of catheter : 22 siliconised latex , 28 hydrogel-coated latex and 27 full silicone catheters . The mean duration of catheterisation was 2.2 days . The urethral inflammatory reaction was assessed from cytological urethral swab specimens . Catheter encrustation was studied using scanning electron microscopic ( SEM ) analysis . The full silicone catheters induced the mildest degree of inflammation in the urethra , the percentage mean of inflammatory cells in smears being 20 % . In both latex catheter groups the value was 36 % . Neither the age of the patients nor the duration of catheterisation had any effect on the inflammatory reaction , which was more marked in patients with haemodynamic abnormalities . The hydrogel coating effectively prevented encrustation , while siliconised latex catheters were the least resistant to encrustation . The inflammatory reaction was variable in all patients . The use of urethral catheters should be restricted and suprapubic tubes should be used instead , particularly in patients with shock-like circulatory changes . By developing the biocompatibility and physical properties of urinary catheters , more compatible devices may be manufactured Intermittent self-catheterization ( ISC ) has addressed the problems of mechanical or functional urological voiding since the 1970s . Patient quality of life is enhanced by the increased independence and security offered by ISC ( Lapides et al , 1972 ) . A r and omized , comparative crossover study was undertaken in two centres to evaluate the performance of SpeediCath ( Coloplast ) and Lofric ( Astra Tech ) catheters . A total of 27 subjects were recruited , all of whom had been performing ISC more than twice a day for longer than 3 months with a coated catheter .  Each catheter was used for 1 week to assess catheter performance and acceptability . There were no significant differences recorded for the performance of each catheter . However , SpeediCath demonstrated favourable statistical significance in relation to ease of use , speed of use , and the concept of water as an integral part of the packaging of the catheter OBJECTIVES To examine the efficacy of bladder catheters impregnated with minocycline and rifampin in reducing  catheter-associated bacteriuria .  METHODS A prospect i ve , r and omized clinical trial was conducted at five academic medical cent 
    Output:
    
Once again the trials were not pooled due to significant heterogeneity ; however , the results of the individual trials indicate a trend toward silicone catheters being less likely to result in adverse urethral effects  in men .
REVIEW ER 'S CONCLUSIONS 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 .
Catheters coated with a combination of minocycline and rifampin may also be beneficial in reducing bacteriuria in hospitalised men catheterised less than one week but this requires further testing .
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 .