Abstract: Nosocomial Urinary Tract Infections

Clair E. Cox, MD. "Nosocomial Urinary Tract Infections." Urology 32 (September 1988) 3: 210-214.

Objectives:
* Dr. Cox discusses the problem of hospital-acquired urinary tract infections (UTI), which account for approximately 40% of all hospital-acquired infections. She reviews the origins, populations at risk, symptoms, and causative organisms of UTI. She then addresses prevention and treatment, discussing surveillance and control programs and the range of available antibiotic therapies.

Conclusions:
* "As many as one million patients a year suffer from hospital-acquired urinary tract infections."
* "Urinary catheterization, invasive diagnostic techniques, and the heavy use of antibiotic drugs are the primary sources for the overwhelming majority of nosocomial urinary tract infections. Genitourinary catheterization is responsible for as much as 80 percent of all hospital-acquired UTI."
* The two patient populations who have the highest risk of acquiring a urinary tract infection include females under fifty years of age, primarily those having received gynecology services; and elderly male patients, in whom UTI is more often associated with bacteremia or death. The populations most in danger of developing serious complications from UTI include diabetics and elderly patients experiencing lengthy hospitalization.
* "Unresolved nosocomial UTIs may account for as many as 56,000 deaths per year."
* ". . . nosocomial UTIs prolong hospitalization by an average of 2.5 days. With the average total hospital cost running approximately $750/day, the additional total bill for a hospital-acquired urinary tract infection would be approximately $1,875. Using even the conservative estimate of one million nosocomial UTIs a year in this country, the total cost to our society could be approaching $2 billion."
* Escherichia coli is the organism that most commonly causes UTI among hospitalized patients. Proteus sp., Klebsiella sp., Pseudomonas aeruginosa, Enterobacter, and Serratia are responsible for most of the remaining infections.
* "Other steps can be taken in addition to surveillance and control programs to lower the rate of nosocomial urinary tract infections. Because most nosocomial UTIs are catheter-related, it is important to concentrate efforts in this area."
* "Due to the substantial economic and social burdens caused by nosocomial urinary tract infections, it is imperative that the nature of these infections be analyzed thoroughly. With the proper care of hospitalized patients and the awareness of risk factors, many nosocomial UTIs may be preventable."

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