Nosocomial Urinary Tract Infections: Secular Trends, Treatment and Economics in a University Hospital

Abstract

During a 71 mo. interval 3024 nosocomial urinary tract infections were identified by prospective surveillance at a hospital. The annual attack rate varied between 2.0 and 3.1/100 admissions. Gram-negative bacilli caused 74% of all urinary infections and recurrent infections in the hospital accounted for only 1%. The most frequent pathogens were Escherichia coli (24%), Pseudomonas aeruginosa (8%), Streptococcus faecalis (7%), Klebsiella pneumoniae (6%) and Proteus mirabilis (6%). Candida spp. caused 10% of the infections and may represent a hospital-acquired pathogen of increasing importance. The burn unit had a significantly higher proportion of Enterobacter infections (21%) than any other service (P < 0.05). The plastic surgery service had more Serratia infections (24%); obstetrics and gynecology had more E. coli infections (47%) relative to other hospital services. Of the patients with nosocomial urinary tract infections, > 99% received antimicrobial drugs; in 63% the chart documented that drug therapy was prescribed specifically for treatment of the urinary infections. Hospital-acquired urinary infections added .apprx. 1 million dollars to hospital expenses during the study interval. Estimates were made of the economic benefits of successful control programs.