Change in Antimicrobial Treatment Patterns with Use of Silver-impregnated Foley Catheters

Background: Catheter-associated urinary tract infections (CAUTI) account for approximately 40% of all healthcare-acquired infections, resulting in over 900,000 incidences per year and the loss of millions of dollars to the health care industry. Adverse consequences include local and systemic morbidity and even death. Silver-impregnated foley catheters have been implemented to reduce rates of CAUTI; however they are more expensive than standard foley catheter. Cost avoidance factors (e.g., cost of infections, antibiotics and length of stay) are sometimes calculated to justify their purchase.

Objective: Evaluate the clinical efficacy of implementation of silver-impregnated catheters.

Methods: The Madison VA Hospital evaluated a silver-impregnated foley catheter using a ‘no-risk’ product trial for 24-months. CAUTI rates using the silver-impregnated foley catheter were compared to the previous 12-months using standard foley catheters. In addition, antimicrobial use and length of stay information were collected for both time periods.

Results: The incidence of CAUTI was 0.83 per 1000 patient-days (19 CAUTI in 22789 patient days) in the pre-intervention period and 0.48 per 1000 patient-days in the intervention period (23 in 48915 patient days). The rate ratio was 0.56 (95% CI 0.29- 1.09), which trended toward significance, P= 0.06. A change in antimicrobial treatment patterns was noted; IV antibiotic use was 53% in standard foley group compared to 13% in silver-impregnated foley group. There were no differences in the total number of patients receiving antimicrobial treatment (89% in standard foley group compared to 70% in silver-impregnated foley group).

Conclusions: Silver-impregnated catheters may be useful in preventing CAUTI. There was a decrease of IV antimicrobial therapy noted in the silver-impregnated catheter group. More studies should be conducted looking at the antimicrobial treatment patterns when silver-impregnated foley catheters are used.