Abstract • From 1975 through 1984, 473 cases of enterococcal nosocomial urinary tract infection (UTI) were identified by prospective hospital-wide surveillance at the University of Virginia Hospital, Charlottesville. The rate of infection increased progressively from 12.3 to 32.2 cases per 10 000 patient discharges, and the proportion of nosocomial UTIs due to this organism increased from 6% to 16%. During the study period, crude mortality was 15%. Patients with the diagnosis of neurogenic bladder accounted for 26% of cases and had a crude mortality of 7.3%; all other cases (74%) had a crude mortality of 18.1% Risk factors associated with fatal outcome in cases having a nosocomial enterococcal UTI included age of more than 50 years, concurrent acute respiratory failure, hospitalization on the internal medicine service, and concurrent gastrointestinal hemorrhage. Enterococcus is the second most frequent cause of nosocomial UTI in our hospital. The emergence of this pathogen may reflect, in part, its selective advantage imparted by resistance to cephalosporin antibiotics. (Arch Intern Med 1986;146:1549-1551) References 1. Centers for Disease Control: CDC Surveillance Summary 1984;32(No. (455) ):155-195. 2. Kunin CM: Urinary tract infections , in Bennett JV, Brachman PS (eds): Hospital Infections . Boston, Little Brown & Co Inc, 1979, pp 239-254. 3. Freeman J, McGowan JE Jr: Risk factors for nosocomial infection. J Infect Dis 1978;138:811-819.Crossref 4. Krieger JN, Kaiser DL, Wenzel RP: Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis 1983;148:57-62.Crossref 5. Givens CD, Wenzel RP: Catheter-associated urinary tract infections in surgical patients: A controlled study on the excess morbidity and costs. J Urol 1980;124:646-648. 6. Platt R, Polk F, Murdock B, et al: Mortality associated with nosocomial urinary tract infection. N Engl J Med 1982;307:637-642.Crossref 7. Sanford JP: Hospital acquired urinary tract infections. Ann Intern Med 1964;60:903-914.Crossref 8. Moody ML, Burke JP: Infections and antibiotic use in a large private hospital, January 1971. Arch Intern Med 1972;130:261-266.Crossref 9. Wenzel RP, Osterman CA, Hunting KJ, et al: Hospital acquired infections: I. Surveillance in a university hospital. Am J Epidemiol 1976;103:251-260. 10. Wenzel RP, Osterman CA, Hunting KJ: Hospital-acquired infections: II. Infection rates by site, service, and common procedure in a university Hospital. Am J Epidemiol 1976;104:645-651. 11. Lennette EH, Balows A, Hausler WJ Jr, et al: Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980. 12. Jones RN: Performance standards for antimicrobial disk susceptibility tests, tentative standards M2-T3. NCCLS 1983;3:469-498. 13. The International Classification of Diseases , Clinical Modifications , ICD-9-CM, 9th revision. Ann Arbor, Mich, Edwards Brothers, 1978. 14. Daniel WW: Biostatistics: A Foundation for Analysis in the Health Sciences , ed 3. New York, John Wiley & Sons Inc, 1983, pp 265-316. 15. Hand DJ: Discrimination and Classification . New York, John Wiley & Sons Inc, 1981, pp 71-154. 16. Evans AC, Chinn AL: The enterococci: With special reference to their association with human disease. J Bacteriol 1947;54:495-512. 17. Feingold DS, Stagg NL, Kunz LJ: Extrarespiratory streptococcal infections: Importance of the various serologic groups. N Engl J Med 1966;275:356-361.Crossref 18. Merritt JL: Urinary tract infections, causes and management, with particular reference to the patient with spinal cord injury: A review. Arch Phys Med Rehabil 1976;57:365-373. 19. Byrd LH, Tapia L, Cheigh JS, et al: Association between Streptococcus faecalis urinary infections and graft rejection in kidney transplantation. Lancet 1978;2:1167-1169.Crossref 20. Tofte RW, Solliday J, Crossley KB: Susceptibilities of enterococci to 12 antibiotics. Antimicrob Agents Chemother 1984;25:532-533.Crossref 21. Kaye D: Enterococci, biologic and epidemiologic characteristics and in vitro susceptibility. Arch Intern Med 1982;142:2006-2009.Crossref 22. Yu VL: Enterococcal superinfection and colonization after therapy with moxalactam: A new broad-spectrum antibiotic. Ann Intern Med 1981;94:784-785.Crossref 23. Stamm WE, Weinstein RA, Dixon RE: Comparison of endemic and epidemic nosocomial infections. Am J Med 1981;70:393-397.Crossref 24. Wenzel RP, Thompson RL, Landry SM, et al: Hospital-acquired infections in intensive care unit patients: An overview with emphasis on epidemics. Infect Control 1983;4:371-375.
Archives of Internal Medicine – American Medical Association
Published: Aug 1, 1986