Epidemiology, treatment and prevention of healthcare-associated urinary tract infections
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Healthcare-associated urinary tract infections (HAUTIs) are the most frequent healthcare-associated infections in general hospitals. They are almost exclusively complicated UTIs, although complicating factors are very heterogenous. HAUTIs are mainly catheter associated. Most of them are asymptomatic and do not need antimicrobial therapy. However, cross-contamination and cross-infection may contribute to distribution of resistant uropathogens. The bacterial spectrum of HAUTI is broad, and antibiotic resistance is common.
The authors reviewed the literature from 2000 to 2010 to determine the epidemiology, prevention and best treatment strategies for HAUTI. The recommendations were summarized by determining the level of evidence and grading each recommendation.
The treatment for HAUTI encompasses treatment for complicating factors as well as antimicrobial chemotherapy. At least in serious UTI, adequate initial antibiotic therapy results in lower mortality. Therefore, the initial antibiotic regimen must provide sufficient antibiotic coverage. This can only be achieved if the local or regional bacterial spectrum and antibiotic resistance patterns of uropathogens are followed continuously. Provisional microbiological findings, such as reports on Gram-stain or certain biochemical results, can lead to early stratification of pathogens and allow a more tailored empiric antibiotic therapy. Antibiotic therapy of HAUTI has to consider therapeutic success in the individual patient and prevention of emergence of antibiotic-resistant mutants. For both aspects, adequate drug selection and dosing are paramount.
Antibiotic treatment for HAUTI should follow prudent antibiotic use to prevent emergence of antibiotic resistance.
KeywordsHealthcare-associated UTI Nosocomial UTI Antibiotic treatment for UTI Emergence of antibiotic-resistant uropathogens
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Hooton TM, Carlet JM, Duse AG, Krieger JN, Steele L, Sunakawa K (2001) Definitions and epidemiology. In: Naber KG, Pechere JC, Kumazawa J, Khoury S, Gerberding JL, Schaeffer AJ (eds) Nosocomial and Health Care Associated Infections in Urology. Health Publication, PlymouthGoogle Scholar
- 7.Wagenlehner FME, Cek M, Kiyota H, Bjerklund-Johansen TE (2010) Epidemiology, treatment and prevention of health-care associated urinary tract infections. In: Naber KG, Schaeffer AJ, Heyns C, Matsumoto T, Shoskes D, Bjerklund-Johansen TE (eds) Urogenital infections. European Association of Urology—International Consultation on Urological Diseases, Arnhem, pp 575–588Google Scholar
- 8.US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research (1992) pp 115–127Google Scholar
- 14.Cited 2011 02.06.2011. Available from: http://www.cdc.gov/nhsn/PDFs/dataStat/2010NHSNReport.pdf
- 15.Bouza E, San Juan R, Munoz P, Voss A, Kluytmans J (2001) A European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004 study). European Study group on nosocomial infection. Clin Microbiol Infect 7(10):532–542PubMedCrossRefGoogle Scholar
- 17.Tandogdu Z, Cek M, Tenke P, Naber K, Bjerklund Johansen TE (2010) Prevalence of nosocomial urinary tract infections: what has changed in years. In: European Urology Supplements. 25th Anniversary EAU congress 2010. European Association of Urology, Barcelona, p 171Google Scholar
- 19.Johansen TE, Cek M, Naber KG, Stratchounski L, Svendsen MV, Tenke P (2006) Hospital acquired urinary tract infections in urology departments: pathogens, susceptibility and use of antibiotics. Data from the PEP and PEAP-studies. Int J Antimicrob Agents 28(Suppl 1):S91–S107PubMedCrossRefGoogle Scholar
- 26.Mathai D, Jones RN, Pfaller MA (2001) Epidemiology and frequency of resistance among pathogens causing urinary tract infections in 1,510 hospitalized patients: a report from the SENTRY Antimicrobial Surveillance Program (North America). Diagn Microbiol Infect Dis 40(3):129–136PubMedCrossRefGoogle Scholar
- 27.Bouza E, San Juan R, Munoz P, Voss A, Kluytmans J (2001) A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI-003 study). European Study Group on Nosocomial Infections. Clin Microbiol Infect 7(10):523–531PubMedCrossRefGoogle Scholar
- 33.Gordon KA, Jones RN (2003) Susceptibility patterns of orally administered antimicrobials among urinary tract infection pathogens from hospitalized patients in North America: comparison report to Europe, Latin America. Results from the SENTRY Antimicrobial Surveillance Program (2000). Diagn Microbiol Infect Dis 45(4):295–301PubMedCrossRefGoogle Scholar
- 35.Pea F, Pavan F, Di Qual E, Brollo L, Nascimben E, Baldassarre M et al (2003) Urinary pharmacokinetics and theoretical pharmacodynamics of intravenous levofloxacin in intensive care unit patients treated with 500 mg b.i.d. for ventilator-associated pneumonia. J Chemother 5(6):563–567Google Scholar
- 39.Grabe M, Bishop M, Bjerklund-Johansen TE, Botto H, Cek M, Lobel B, Naber KG, Palou J, Tenke P, Wagenlehner F (2009) Guidelines on urological infections. In: EAo Urology (ed) European Association of Urology Guidelines. European Association of Urology, Arnhem, pp 1–110Google Scholar
- 45.Bach T, Netsch C, Haecker A, Michel MS, Herrmann TR, Gross AJ (2010) Thulium: YAG laser enucleation (VapoEnucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 28(1):39–43Google Scholar
- 46.Lourenco T, Shaw M, Fraser C, MacLennan G, N’Dow J, Pickard R (2010) The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J Urol 28(1):23–32Google Scholar
- 51.Moore KN, Fader M, Getliffe K (2007) Long-term bladder management by intermittent catheterisation in adults and children. Cochrane Database Syst Rev (4):CD006008Google Scholar