title: 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.
abstract: OBJECTIVE
  To obtain information on the microbiology workload, etiology and antimicrobial susceptibility of urinary tract infection (UTI) pathogens isolated in European hospitals.
  
  
  METHODS
  We collected data available in the microbiology units of a large sample of European hospitals regarding the laboratory workload, diagnostic criteria, and etiology and antimicrobial resistance of the urinary isolates collected on one day (the study day).
  
  
  RESULTS
  Data were received from a total of 228 hospitals from 29 European countries. The average rate of urine samples cultured per 1000 admissions in 1999 was 324. The criteria to consider a positive urine culture as significant were quite variable; > or =10(4) colony-forming units (CFU)/mL for bacteria or > or =10(3) CFU/mL in the case of yeasts were the most used cut-off points. On the study day, a total of 607 micro-organisms from 522 patients with nosocomial UTI were isolated. The six most commonly isolated micro-organisms were, in decreasing order: Escherichia coli (35.6%), Enterococci (15.8%), Candida (9.4%), Klebsiella (8.3%), Proteus (7.9%) and Pseudomonas aeruginosa (6.9%). Pseudomonas was isolated more frequently in non-EU countries. The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin.
  
  
  CONCLUSIONS
  Nosocomial UTI accounts for an important proportion of the workload in microbiology laboratories. A consensus on the practice and interpretation of urine cultures in Europe is needed. The levels and patterns of resistance of UTI pathogens must be a serious cause for concern and a clear reason for stricter guidelines and regulations in antimicrobial policy.
authors.affiliation: Servicio de Microbiología Clínica y Enfermedades Infecciosas_VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain. ebouza@microb.net
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.forename: R
authors.initials: R
authors.lastname: San Juan
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Voss
authors.forename: J
authors.initials: J
authors.lastname: Kluytmans
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000652:urine; D004352:Drug Resistance, Microbial; D005060:Europe / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000209:etiology* / Q000382:microbiology* / Q000652:urine; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents