Elsevier

European Urology

Volume 51, Issue 4, April 2007, Pages 1100-1112
European Urology

Infections
Prevalence of Hospital-Acquired Urinary Tract Infections in Urology Departments

https://doi.org/10.1016/j.eururo.2006.08.012Get rights and content

Abstract

Objectives

The aim of our study was to register the prevalence of nosocomial urinary tract infections (NAUTIs) in urology sections in Europe and Asia.

Methods

A total of 6033 hospitalised patients in 194 different urology departments were screened in two Internet-based studies. Detailed reports on 727 patients with NAUTI were provided.

Results

The prevalence of NAUTI was 10% in the Pan European Prevalence (PEP) study, 14% in the Pan EuroAsian Prevalence (PEAP) study, and 11% in the combined analysis. The largest group was asymptomatic bacteriuria (29%) followed by cystitis (26%), pyelonephritis (21%), and urosepsis (12%). There were significant differences between regions and types of hospitals.

Conclusions

NAUTI is a large problem for urologic patients and causes huge extra costs for hospitals.

Introduction

A nosocomially acquired infection is an infection obtained during hospitalisation. The incidence has been reported as high as 45% in intensive care units, and depends on the size of the hospital and the size of the clinical department [1]. Urinary tract infections (UTIs) account for about 40% of nosocomial infections [2].

A recent pan-European study on the incidence of microbiologically proven nosocomially aquired urinary tract infections (NAUTIs) in hospitals calculated the prevalence to 10.65 per 1000 patient days [3]. If clinically diagnosed UTIs had been included, it is likely that the incidence of UTIs would be much higher than those reported [3], but such figures are not yet known.

Recommendations on how to monitor NAUTI were worked out by an international group of experts sponsored by the World Health Organization and the United States Centers for Disease Control and Prevention (CDC) [4]. In developed countries, a continuous IT-based system was considered to be possible.

On this background we established an IT-based monitoring system and carried out two consecutive international prevalence studies on NAUTI in urology departments by means of the Internet in the year 2003 and 2004. The aim of this paper is to report the prevalence of clinically and microbiologically proven NAUTI.

Section snippets

Organisation and protocol

The study was initiated and organised by the board of the European Society for Infections in Urology (ESIU)1. Both studies were fully sponsored by the European

Participation

The 2003 PEP study recruited investigators from 216 hospitals; 93 investigators from 23 countries completed the hospital registration form and registered the prevalence of NAUTI. Investigators from 210 hospitals registered for the 2004 PEAP study; 101 investigators from 24 countries completed the hospital forms and were included in the study. Forty-two urology departments took part in both studies. In the analysis we included each department only once. When a department participated in both

Discussion

A continuous registration of all cases of NAUTI gives complete information about incidence and is the ideal way of monitoring a given unit, but it is too time consuming for most urologists. The lack of information in a short-term prevalence study may be compensated to some extent if many hospitals take part in the study [9]. We believe that our one-day studies comprising 194 urology units give an important overview of nosocomial infections in urology departments in Europe and Asia. These are

Conclusions

The prevalence of NAUTI was 11%. The largest group was asymptomatic bacteriuria with 29% followed by cystitis (26%), pyelonephritis (21%), urosepsis (12%), and other infections (12%). There were significant differences between regions and types of hospitals. There were also significant differences in microbiologic evidence for diagnosing urosepsis. The numbers of bacteriologic cultures taken varied widely among hospitals.

The Internet portal of the EAU proved to be a valuable instrument for

Acknowledgements

Our coauthor Leonid Stratchounski died in June 2005. His contribution to this study was invaluable.

We also acknowledge the investigators listed in Appendix A; they also are co-authors and contributed the local data to the PEP and PEAP studies.

We thank Geertjon Jepkes and Rogier Spieker for programming and all kinds of technical support; and Karin Plass, Astrid Driessen-Venhorst, and Angela Terberg for administrative and secretarial assistance. All work at the EAU central office.

We thank Alexey

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Cited by (0)

1

Leonid Stratchounski died in June 2005.

2

See Appendix A.

3

See Acknowledgements.

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