Original Research Intermittent Catheterization With a Hydrophilic-Coated Catheter Delays Urinary Tract Infections in Acute Spinal Cord Injury: A Prospective, Randomized, Multicenter Trial Diana D. Cardenas, MD, MHA, Katherine N. Moore, PhD, RN, CCCN, Amy Dannels-McClure, RN, CNS, ND, William M. Scelza, MD, Daniel E. Graves, PhD, Monifa Brooks, MD, Anna Karina Busch, PhD Objective: To investigate whether intermittent catheterization (IC) with a hydrophilic- coated catheter delays the onset of the first symptomatic urinary tract infection (UTI) and reduces the number of symptomatic UTIs in patients with acute spinal cord injury (SCI) compared with IC with standard, uncoated catheters. Design: A prospective, randomized, parallel-group trial. Setting: Fifteen North American SCI centers. Participants were followed up while in the hospital or rehabilitation unit (institutional period) and up to 3 months after institutional discharge (community period). The maximal study period was 6 months. Participants: A total of 224 subjects with traumatic SCI of less than 3 months’ duration who use IC. Methods: The participants were randomized within 10 days of starting IC to either single-use hydrophilic-coated (SpeediCath) or polyvinyl chloride uncoated (Conveen) catheters. Main Outcome Measurements: The time from the first catheterization to the first antibiotic-treated symptomatic UTI was measured as well as the total number of symptom- atic UTIs during the study period. Results: The time to the first antibiotic-treated symptomatic UTI was significantly delayed in the hydrophilic-coated catheter group compared with the uncoated catheter group. The delay corresponded to a 33% decrease in the daily risk of developing the first symptomatic UTI among participants who used the hydrophilic-coated catheter. In the institutional period, the incidence of antibiotic-treated symptomatic UTIs was reduced by 21% (P  .05) in the hydrophilic-coated catheter group. Conclusions: The use of a hydrophilic-coated catheter for IC is associated with a delay in the onset of the first antibiotic-treated symptomatic UTI and with a reduction in the incidence of symptomatic UTI in patients with acute SCI during the acute inpatient rehabilitation. Using a hydrophilic-coated catheter could minimize UTI-related complica- tions, treatment costs, and rehabilitation delays in this group of patients, and reduce the emergence of antibiotic-resistant organisms. PM R 2011;3:408-417 INTRODUCTION Spinal cord injury (SCI) commonly results in neurogenic bladder dysfunction. Intermittent catheterization (IC) is accepted as a safe and effective method for maintaining bladder and renal health in individuals with neurogenic bladder dysfunction. However, IC several times a day places an individual at risk for urethral trauma, hematuria, and, particularly, symptomatic urinary tract infections (UTI) [1]. Urinary tract morbidity ranks as a leading cause of hospital readmission in individ- uals with SCI [2] and is a key factor in mortality in this population [3,4]. To date, there is weak evidence to support sterile IC technique as a way of controlling UTI, and D.D.C. Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL 33136. Address correspondence to D.D.C.; e-mail: DCardenas@med.miami.edu Disclosure: 2A, Neuralstem, Inc. K.N.M. Faculty of Nursing, University of Al- berta, Edmonton, Alberta Disclosure: 3A, International Continence Soci- ety; 7B, support for study data collection at University of Alberta A.D.-M. Research Department, Craig Hospi- tal, Englewood, CO Disclosure: nothing to disclose W.M.S. Spinal Cord Injury Program, Carolinas Rehabilitation, Charlotte, NC Disclosure: nothing to disclose D.E.G. The Institute for Rehabilitation and Research (TIRR), Baylor College of Medicine, Houston, TX Disclosure: nothing to disclose M.B. Kessler Institute for Rehabilitation, West Orange, NJ Disclosure: nothing to disclose A.K.B. Clinical Regulatory Development, Colo- plast A/S, Humlebaek, Denmark Disclosure: 1A; 6B, employed by Coloplast Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org The study was supported by Coloplast A/S. Submitted for publication September 15, 2010; accepted January 10, 2011. PM&R © 2011 by the American Academy of Physical Medicine and Rehabilitation 1934-1482/11/$36.00 Vol. 3, 408-417, May 2011 Printed in U.S.A. DOI: 10.1016/j.pmrj.2011.01.001 408