A randomized, controlled, prospective clinical trial involving 696 hospitalized patients was undertaken to determine the effectiveness of 1% silver sulfadiazine cream applied twice daily to the urethral meatus in preventing transurethral catheter-associated bacteriuria. The overall incidence of bacteriuria was 11.4% (38/332) in the treated group and 13.2% (48/364) in the untreated group (P = .56; odds ratio, 0.85; 95% confidence interval, 0.53-1.37). Cox proportional hazards analysis identified female sex, lack of antibiotic use, and a positive initial meatal culture (but not treatment randomization or lack of urinemeter use) as independent variables associated with an increased risk of bacteriuria. Survival curve analysis of subgroups stratified by sex and antibiotic use failed to detect an effect of silver sulfadiazine on the rate of bacteriuria. Meatal care with silver sulfadiazine cream did not prevent the development of catheter-associated bacteriuria in short-term catheterized patients.