背景:清洁间歇性导尿(CIC)与尿路感染(UTI)的风险增加有关,尿道创伤,尿道狭窄,血尿,和痛苦。第一批导管是由聚乙烯碳(PVC)开发的。已经开发了几种类型的导管来减少这些并发症,如具有亲水性涂层的那些。
目的:进行系统回顾和荟萃分析,以评估亲水性涂层导管与未涂层导管相比对使用CIC的患者UTI发生率的有效性。
方法:在OVID,Embase,Scopus,WebofScience,PubMed,和中央数据库。随机对照试验(RCT)或随机交叉试验,比较使用亲水性与亲水性的患者的UTI和血尿发生率确定了用于CIC的非亲水性导管.使用“修订的Cochrane偏倚风险工具”(RoB2)评估所选试验的偏倚风险。“结果表示为具有95%置信区间(CI)的风险比(RR),在随机效应模型下。使用ReviewManager5.4软件分析数据。
结果:分析了9项研究,共525例CIC患者。总的来说,与未涂覆导管相比,使用亲水性导管发生UTI的风险较低(RR=0.78;95%CI0.62~0.97;I2=37%).其中五项研究包括>18岁的患者,显示使用亲水性导管可减少UTI(RR=0.83;95%CI0.74-0.93;I2=0%)。当比较单次使用的未涂覆导管与亲水性导管时,UTI发展没有差异。然而,异质性高(RR=0.77;95%CI0.59-1.00;I2=57%).关于血尿风险降低,我们无法确定使用亲水性导管与未涂覆导管之间的差异(RR=1.02;95%CI0.66~1.60).
结论:我们发现,在成人中使用亲水性导管可降低尿路感染的风险,异质性低。关于血尿,没有证明存在显著差异。我们没有发现儿科人群中UTI风险降低的显著差异。由于缺乏报道的信息,无法对尿道创伤的存在进行荟萃分析。
BACKGROUND: Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating.
OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC.
METHODS: A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the \"Revised Cochrane risk-of-bias tool for randomized trials (RoB 2).\" The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software.
RESULTS: Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60).
CONCLUSIONS: We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.