title: Effect of silver-coated urinary catheters: efficacy, cost-effectiveness, and antimicrobial resistance.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are the most common nosocomial infection experienced by patients in United States hospitals and are responsible for significant morbidity and excess hospital costs. The purpose of this study was to determine the efficacy of a silver alloy, hydrogel-coated, urinary catheter in the prevention of catheter-associated UTI, to assess the cost effectiveness of the coated catheter, and to test for the emergence of silver-resistance in urinary microbial isolates.
  
  
  METHODS
  A 2-year prospective surveillance study in 10 patient care units was conducted to determine the rate of catheter-associated UTI. Historic control data was utilized to assess the effect of the coated catheter. A cost-effectiveness analysis was conducted using a range of cost estimates. Silver susceptibility was determined for microbes responsible for catheter-associated UTI.
  
  
  RESULTS
  Data were analyzed using a Poisson regression model. The rate of catheter-associated UTI fell from 6.13/1000 catheter-days during the period 1999-2000 to 2.62/1000 catheter-days during 2001-2002 ( P = .002). Calculated cost savings varied widely. Modest savings were achieved at the realistic lower cost estimates. No silver-resistant microbes were recovered in the susceptibility tests.
  
  
  CONCLUSIONS
  The introduction of a silver alloy, hydrogel-coated urinary catheter was associated with a significant decline in nosocomial UTI and cost savings over the range of cost estimates. Silver-resistant urinary pathogens were not recovered from patients experiencing catheter-associated UTI during the study period.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, 984031 Nebraska Medical Center, Omaha, NE 68198, USA. merupp@unmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.forename: Theresa
authors.initials: T
authors.lastname: Fitzgerald
authors.forename: Nedra
authors.initials: N
authors.lastname: Marion
authors.forename: Virginia
authors.initials: V
authors.lastname: Helget
authors.forename: Susan
authors.initials: S
authors.lastname: Puumala
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Paul D
authors.initials: PD
authors.lastname: Fey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002408:Catheters, Indwelling; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D004867:Equipment Design; D017721:Hospital Costs; D006801:Humans; D011446:Prospective Studies; D012834:Silver / Q000627:therapeutic use*; D014546:Urinary Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D012834:Silver