***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND  Catheter-associated urinary tract infection ( CAUTI ) is the most common nosocomial infection , accounting for more than 1 million cases each year in US hospitals and nursing homes . OBJECTIVE To define the clinical features of CAUTI . SETTING AND PATIENTS A university hospital ; 1,497 newly catheterized patients . DESIGN Every day that the catheter was in place , a quantitative urine culture and urine leukocyte count were obtained , and the patient was queried by a research worker regarding symptoms . To more precisely define the role of CAUTI in patients ' symptoms , a subset of 1,034 patients , 89 of whom developed CAUTI with more than 10(3 ) colony-forming units per milliliter , who did not have another potentially confounding site of infection besides the urinary tract , was analyzed . OUTCOME MEASURES Presence of fever , symptoms commonly associated with community-acquired urinary tract infection , and peripheral leukocytosis . RESULTS There were 235 new cases of nosocomial CAUTI during the study period . More than 90 % of the infected patients were asymptomatic ; only 123 infections ( 52 % ) were detected by patients ' physicians using the hospital laboratory . In the subset analysis , there were no significant differences between patients with and without CAUTI in signs or symptoms commonly associated with urinary tract infection-fever , dysuria , urgency , or flank pain-or in leukocytosis . Only 1 of the 235 episodes of CAUTI that were prospect ively studied was unequivocally associated with secondary bloodstream infection . CONCLUSIONS Whereas CAUTIs are a major reservoir of antibiotic-resistant organisms in the hospital , they are rarely symptomatic and infrequently cause bloodstream infection . Symptoms referable to the urinary tract , fever , or peripheral leukocytosis have little predictive value for the diagnosis of CAUTI The tendency to develop bacteriuria during the use of various forms of indwelling catheters was evaluated in a r and omized trial in 90 patients . A silver alloy and hydrogel-coated Foley catheter ( SHC ) was compared to a non-coated catheter ( NC ) and a catheter coated only with hydrogel ( HC ) . Three patients ( 10 % ) with SHC catheters , 10 ( 33 % ) patients with HC catheters , and 15 ( 50 % ) patients with NC catheters developed bacteriuria ( greater than 10(5 ) organisms/ml ) . The difference in the rate of bacteriuria after 5 days of catheterization was statistically significant between the SHC catheter and the NC catheter ( p less than 0.002 ) . There was no significant difference between the SHC catheter and the HC catheter , nor was there a significant difference between the HC catheter and the NC catheter . The toxic effects , as estimated by the IC50 value , of the urinary catheter material used was eluci date d in an experimental fibroblast model . The IC50 value for the NC catheter was 33.9 % , HC catheter 72.2 % and for the SHC catheter 98.1 % During a 23-month study , we identified 1,233 patients with nosocomial urinary tract infections ( UTIs ) among 40,718 consecutive admissions by using a st and ardized , prospect i ve system of hospital-wide surveillance .  Nosocomial bloodstream infections ( BSIs ) occurred in 565 patients , 32 of whom had BSIs originating from UTIs , for an attack rate of 2.7 per 100 patients with nosocomial bacteriuria . Patients with UTIs due to Serratia marcescens were most likely to develop secondary BSIs ( rate , 16 per 100 ) compared to patients with nosocomial UTIs due to other organisms ( rate , less than or equal to 4.3 per 100 ; P less than 0.05 ) . Furthermore , the median interval between documentation of UTI and of secondary BSI was 24 days for patients with infections due to S marcescens compared to one day for the entire group ( P less than 0.005 ) . Risk factor analysis indicated that men with UTIs were more likely to develop secondary BSIs than were women ( P less than 0.05 ) . Intensified infection control efforts are particularly necessary with high-risk groups such as bacteriuric men -- especially among those patients with UTIs due to S marcescens -- to reduce the incidence of secondary , hospital-acquired BSIs OBJECTIVE To determine the additional direct costs of hospitalization attributable to catheter-associated urinary tract infection ( CAUTI ) in 1,497 newly catheterized patients . DESIGN Prospect i ve observational and laboratory study . SETTING University hospital . METHODS Data were collected on risk factors for CAUTI  ( defined as > 10(3 ) colony-forming units [CFU]/mL ) , severity of illness , and diagnostic and therapeutic interventions in consenting newly catheterized patients . Daily urine cultures were obtained from each newly catheterized patient , but the results of these cultures were not revealed to his or her physician . During the study , one of the investigators ( DGM ) review ed each patient 's record and made a judgment as to which of the diagnostic tests and treatments ordered and what incremental length of stay could reasonably be ascribed to his or her CAUTI . The total hospital costs for each patient were also obtained . RESULTS Overall , 235 patients acquired CAUTIs during the study ; most of the CAUTIs were completely asymptomatic , and only 52 % were diagnosed by the patients ' physicians using the hospital laboratory . Only 1 patient with a CAUTI had a secondary bloodstream infection . Thirty-three ( 13 % ) of the CAUTIs were caused by Escherichia coli ; 63 ( 25 % ) by Klebsiella , Enterobacter , Citrobacter , Pseudomonas aeruginosa , or other antibiotic-resistant , gram-negative bacilli ; 87 ( 35 % ) by enterococci or staphylococci ; and 67 ( 27 % ) by C and ida species . The 123 CAUTIs diagnosed by the hospital laboratory were judged to have been responsible for an additional $ 20,662 in extra costs of diagnostic tests and $ 35,872 in extra medication costs , a mean of $ 589 ( median , $ 356 ) per CAUTI . CAUTIs caused by E. coli cost considerably less than infections caused by other gram-negative bacilli ( $ 363.3 + /- $ 228.2 vs $ 690.4 + /- $ 783.7 ; P = .02 ) or yeasts ( $ 821.2 + /- $ 2,169.9 ) . There were less striking differences in the costs per CAUTI caused by staphylococci or enterococci ( $ 387.1 + /- $ 434.8 ) . CONCLUSIONS The extra direct costs associated with nosocomial CAUTI found in this prospect i ve study , which was done in the era of managed care during the late 1990s , are substantially lower than those reported in the largest comparable studies done more than 15 years ago , most of which were retrospective , reflecting the powerful impact of cost-containment measures that are now implemented in managed care 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 prospect i ve 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 BACKGROUND Urinary tract infections ( UTIs ) account for 30 % to 40 % of nosocomial infections result ing in morbidity , mortality , and increased length of hospital stay . OBJECTIVE To assess the efficacy of a silver-alloy , hydrogel-coated latex urinary catheter for the prevention of nosocomial catheter-associated UTIs . METHODS A 12-month r and omized crossover trial compared rates of nosocomial catheter-associated UTI in patients with silver-coated and uncoated catheters .  A cost analysis was conducted . RESULTS There were 343 infections among 27,878 patients ( 1.23 infections per 100 patients ) during 114,368 patient-days ( 3.00 infections per 1000 patient-days ) . The relative risk of infection per 1000 patient-days was 0.79 ( 95 % confidence interval , 0.63 - 0.99 ; P = .04 ) for study wards r and omized to silver-coated catheters compared with those r and omized to uncoated catheters . Infections occurred in 291 of 11,032 catheters used on study units ( 2.64 infections per 100 catheters ) . The relative risk of infection per 100 silver-coated catheters used on study wards compared with uncoated catheters was 0.68 ( 95 % confidence interval , 0.54 - 0.86 ; P = .001 ) . Fourteen catheter-associated UTIs ( 4.1 % ) were complicated by secondary bloodstream infection . One death appeared related to the secondary infection . Estimated hospital cost savings with the use of the silver-coated catheters ranged from $ 14,456 to $ 573,293 . CONCLUSIONS The risk of infection declined by 21 % among study wards r and omized to silver-coated catheters and by 32 % among patients in whom silver-coated catheters were used on the wards . Use of the more expensive silver-coated catheter appeared to offer cost savings by preventing excess hospital costs from nosocomial UTI associated with catheter use . Arch Intern Med . 2000;160:3294 - 3298 Catheter-related nosocomial urinary tract infection in postoperative orthopedic and trauma patients was studied prospect ively using nitrofuroxone-impregnated urinary catheters ( study group ) and regular silicone-coated Foley catheters .  Fifty adults in each group were r and omly assigned . In Group A , antibiotic-impregnated catheters were used , and in the other , non-antibiotic-impregnated urinary catheters were used ( Group B ) . The variables studied were age , sex , type of surgery , duration of surgery , number of catheter days , days of intravenous line , and hospital days . In patients , urinary tract infection ( UTI ) was diagnosed by culture and the organism was isolated . The average age in the study group was 43.90 years ( range , 14 - 95 years ) compared with the control group ( mean age , 42.22 years ; range , 14 - 102 years ) .  Catheter days in the nitrofuroxone-impregnated catheters was 7.9 days ( range , 2 - 37 days ) versus 7.2 days ( range , 2 - 30 days ) . The intravenous line in the group was 9.16 days ( range , 2 - 35 days ) versus 8.8 days ( 2 - 22 days ) . There were six infections ( P = 0.028 ) in the control group compared with the study group . The length of operation was similar in each group . Our study indicates that nitrofuroxone-impregnated catheters have the potential to reduce nosocomial catheter-related UTIs in postoperative orthopedic and trauma patients Objective : To assess the impact of nosocomial infection on the mortality rate in an intensive care unit ( ICU ) . Design : Prospect i ve cohort study . Setting : The ICU of the University of Granada Hospital in Spain . Patients : All patients ( n=279 ) admitted for ≥48 hrs at the ICU between December 1986 and April 1988 . Measurements : Nosocomial infections were diagnosed according to Study on the Efficacy of Nosocomial Infection Control ( SENIC ) and Centers for Disease Control criteria . Patient severity on admission 
    Output:
    
Key Summary Points R and omized or quasi-r and omized clinical trials of antimicrobial urinary catheters currently marketed in the United States ( i.e. , nitrofurazone-coated and silver alloycoated catheters ) provide little or no data on these devices ' effect on symptomatic urinary tract infection , morbidity , secondary bloodstream infection , mortality rates , or associated health care costs .
Both nitrofurazone-coated and silver alloycoated catheters seem to reduce the development of asymptomatic bacteriuria during short-term ( < 30 days ) use , in comparison with latex or silicone control catheters .