Epidemiology and Control of Urinary Tract Infections in Intensive Care Patients

Healthcare-associated infections (HAIs) are one of the most common complications in hospitalized patients, leading to increased hospitalization, morbidity and mortality and associated with additional costs (Geffers and Gastmeier, 2011). Urinary tract infection (UTI) is common in hospitalized patients. It has been reported that in U.S. hospitals, among adults and children outside of the intensive care units (ICUs), the urinary tract is the most common site of HAI, accounting for 36% of infections, followed by surgical site infections (20%), bloodstream infections and pneumonia (11%, each) and other infection types (all 22%) (Klevens et al., 2007). Almost all healthcare-associated UTIs are caused by instrumental urinary tract procedures. In fact, the presence of a foreign body in the urinary tract predisposes the patient to UTI and alters the body’s ability to eradicate bacteria (Gray et al., 2010). It has been estimated that more than 80% of UTIs are associated with an indwelling catheter (Anderson et al., 2007) and notably, catheter-associated UTI (CAUTI) has been related with such complications that prolonged hospital stay, and increased cost, morbidity and mortality (Gould et al., 2009). Urologic patients should be considered at high risk for a healthcare-associated UTI, because they are usually exposed both to urethral catheterization and instrumentation of the urinary tract. In a surveillance study conducted in an urologic clinic of an Italian university hospital the incidence of symptomatic UTIs was 1.4 per 1000 patient-days (Agodi et al., 2007).