Nosocomial urosepsis: Analysis of 218 cases

AbstractObjectives: To determine the contribution of bacteremic urinary tract infections to the problem of nosocomial blood stream infections, and trends over time with respect to frequency, distribution, and causative organism of these infections.Methods: Positive blood cultures from the hospital's microbiology laboratory (August 1986 to July 1994) were prospectively reviewed. Patient charts were reviewed to determine source of infection and short-term (1 week) outcome.Results: Of 1789 episodes of nosocomial blood stream infection, 218 (12.2%) were of urinary tract origin. Urinary tract source bacteremia occurred in 0.89 of 1000 admissions and 0.87 of 10,000 patient days, and the rate did not change significantly through the study period, although the rate for nosocomial blood stream infections from all sources progressively increased. Cases were widely distributed throughout the institution and were associated with a 1-week mortality of 4.5%. Mortality was not associated with patient care unit or microbial etiology. Escherichia coli was the most common microbial cause (36.8%); Enterococcus spp (12.3%), Pseudomonas spp (8.9%), and Candida spp (5.1 %) were also relatively common. Patient care unit did not predict microbial etiology.Conclusion: Nosocomial urosepsis is a widely distributed cause of nosocomial blood stream infection, but is not increasing in frequency or changing in microbial etiology. Empiric treatment regimens for this problem must include coverage for Pseudomonas and Enterococcus species