title: [Urinary tract infections due to wide spectrum beta lactamase producing enterobacteriaceae].
abstract: OBJECTIVE
  The aim of this study was to specify the characteristics of enterobacterial urinary infections producing wide spectrum beta-lactamase (WSBL) and the management strategies for these patients infected in geriatric wards.
  
  
  METHODS
  The prevalence, bacteriological characteristics and treatment regimens of enterobacterial urinary infections producing WSBL, diagnosed in a geriatric department of internal medicine from May 1977 to April 2001, were studied retrospectively.
  
  
  RESULTS
  Sixty-six enterobacterial urinary infections producing WSBL were diagnosed, with 53 (80%) of them acquired in the ward. They represented 1.6% of admissions and concerned 24 men and 42 women (sex ratio: 0.57), with a mean age of 87 years. Their prevalence was of 20 in the 1st year, 11 in the 2nd, 9 in the third and 26 in the 4th year. The mean duration of hospitalization of infected patients was 4.5-fold longer (90 vs. 20 days) and the mortality rate 2-fold higher (32 vs. 14%). Enterobacter aerogenes were responsible for half (46%) of the WSBL urinary infections. The skin was invaded by enterobacteria in 67% and the feces in 57% of cases. More than one third of the urinary infections treated relapsed, and digestive decontamination was only efficient in half of the patients treated.
  
  
  CONCLUSIONS
  This 4-year study emphasizes the limits of antibiotherapy in eradicating WSBL-producing enterobacteria and the fact that only the strict respect of hygiene by all caregivers (isolation of patients exhibiting WSBL and washing-disinfection of the hands between each patient) limits the incidence of such infections.
authors.affiliation: Centre de gérontologie des hôpitaux universitaires, hôpital de la Robertsau, Strasbourg. Georges.Kaltenbach@chru-strasbourg.fr
authors.forename: G
authors.initials: G
authors.lastname: Kaltenbach
authors.forename: D
authors.initials: D
authors.lastname: Heitz
authors.forename: T
authors.initials: T
authors.lastname: Vogel
authors.forename: M
authors.initials: M
authors.lastname: Noblet-Dick
authors.forename: C
authors.initials: C
authors.lastname: Martin-Hunyadi
authors.forename: M
authors.initials: M
authors.lastname: Kiesmann
authors.forename: F
authors.initials: F
authors.lastname: Jehl
authors.forename: M
authors.initials: M
authors.lastname: Berthel
authors.forename: F
authors.initials: F
authors.lastname: Kuntzmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology*; D018432:Drug Resistance, Multiple / Q000502:physiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D005853:Geriatrics; D006748:Hospital Departments; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012008:Recurrence; D015996:Survival Rate; D017211:Treatment Failure; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D018440:beta-Lactam Resistance / Q000502:physiology*; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases