[Urinary tract infections due to wide spectrum beta lactamase producing enterobacteriaceae].
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.
Kaltenbach
G
G
Centre de gérontologie des hôpitaux universitaires, hôpital de la Robertsau, Strasbourg. Georges.Kaltenbach@chru-strasbourg.fr
Heitz
D
D
Vogel
T
T
Noblet-Dick
M
M
Martin-Hunyadi
C
C
Kiesmann
M
M
Jehl
F
F
Berthel
M
M
Kuntzmann
F
F
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
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases