Incidence of nosocomial urinary tract infections on a surgical intensive care unit and implications for management.

The incidence of nosocomial infections (NIs) in our surgical intensive care unit was evaluated with special consideration of nosocomial urinary tract infections (NUTIs). The trial was a prospective, single-centre, 6-month cohort study. Infections according to CDC criteria, pathogens, devices, APACHE II scores, infection parameters and urinalysis were noted. In total, 420 patients (1543 patient days) were evaluated. Of these, 25% had 160 infections of which 110 were NIs. Mean APACHE II score in all infected patients was 16 versus 12 in non-infected patients (P<0.0001). Of the NIs, 25% were not ICU acquired and 75% were ICU acquired. UTIs accounted for 28% of the NIs, lower respiratory tract infections for 21%, pneumonia for 12% and bloodstream infections for 11%. The rates of urinary-catheter-associated UTIs varied between 4.2 (symptomatic UTI) and 14.0 (asymptomatic UTI). Although asymptomatic NUTI usually deserves no therapy, it needs to be considered carefully in terms of its environmental impact on the emergence of bacterial resistance.