Prevention of catheter-associated urinary tract infection: a cost-benefit analysis.

A cost-benefit analysis was used to assess four strategies to prevent catheter-associated urinary tract infections in an acute care setting. Routine use of catheters with sealed collection junctions, selective use of these catheters, and oral antibiotic prophylaxis all result in fewer deaths, fewer infections, and lower overall costs than not using any of these. Routine use of sealed junction catheters results in fewer infections and deaths than does selective use. When the cost of a nosocomial urinary tract infection is +500, routine use of sealed junction catheters is also less expensive than selective use in many circumstances. Oral antibiotic prophylaxis would result in the lowest net cost and the fewest deaths and infections, if it were as effective as parenteral prophylaxis, if more than 72% of patients received it, and if important negative factors such as selection of antimicrobial resistance and adverse drug reactions are not considered. When there is no extra cost of sealed junction catheters, their use is less expensive than the oral prophylaxis strategy if the total cost of oral prophylaxis, including the cost of adverse reactions, is greater than +15. If the extra cost of sealed junction catheters is +4 per unit, their use is less expensive than oral prophylaxis when its cost exceeds +35. Prevention of catheter-associated urinary tract infection reduces the overall cost of patient care, even when the prevention itself incurs costs. This analysis supports the routine use of sealed junction catheters in most acute care situations that require indwelling catheter drainage. Currently, we do not recommend routine antibiotic prophylaxis.