Definitions of bacteriuria used in the trials varied. Two allocated patients by week or month. Neither investigators nor patients were blinded to type of catheter used in any study. This is a fascinating report. The fact that all four silver alloy studies were done at the same institution by the same investigators.
Bandolier thinks caution is needed, as, to be fair, do the authors.
But the clear and well-written nature of the report makes it ideal for anyone wanting to use it for critical appraisal work, and going on from there to design a trial which might prove the point without dispute. There is also an interesting health economics perspective here. It should be possible to examine how much better silver alloy catheters would have to be for them to be cost-effective, given some reasonable assumptions about rates of infection with uncoated catheters. This paper makes you think, especially about issues like technology creep, where innovations may be small in their costs and consequences, but where the pennies add into many pounds. It also makes you think we should be doing more, and better, and faster, than we seem to be doing now.