title: Hospital-acquired urinary tract infection point prevalence in Turkey: differences in risk factors among patient groups.
abstract: BACKGROUND
  The aim of this study was to determine the point prevalence of nosocomial urinary tract infections (UTIs) and to investigate risk factors for pathogen type (E. coli vs. others) and extended-spectrum beta-lactamase (ESBL) positivity among nosocomial UTI patients.
  
  
  METHODS
  A questionnaire consisting of 44 questions on demographic data and risk factors of UTI cases was sent to 51 tertiary care hospitals. Univariate and multivariate analyses were conducted.
  
  
  RESULTS
  The overall prevalence of UTI was 1.82% (483/26534). The prevalence of UTI was higher in intensive care units (ICUs) with 6.77% versus 1.45% outside ICUs. Hospitals of the Ministry of Health (compared to university hospitals), hospitals in less developed provinces and hospitals with bed capacity < 500 had higher UTI prevalence. Patients without a urinary catheter were more likely to have received immunosuppressive therapy, current corticosteroid use, renal transplantation and uterine prolapsus and less likely to have another infection outside the urinary tract, as compared to catheterized patients. Among the 422 culture-positive patients, the most common pathogen was E. coli (45.5%). The risk factors increasing the likelihood of E. coli in urine culture were being female, history of urinary tract operation, no use of antibiotics in the preceding three months and infection outside the urinary tract. There were 247 patients with E. coli or Klebsiella spp. positive in culture. Among these, 61% (n=151) were ESBL- positive. Among patients having E. coli/Klebsiella positive in culture, antibiotic use in the preceding three months and history of urinary tract operation were the independent risk factors significantly increasing the risk of ESBL.
  
  
  CONCLUSIONS
  The reasons underlying the high prevalence of nosocomial UTIs, and a better understanding of the risk factors might lead to improved control of these infections.
authors.affiliation: Medical Faculty Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey. tasbakan@yahoo.com.
authors.forename: Meltem
authors.initials: M
authors.lastname: Isikgoz Tasbakan
authors.forename: Raika
authors.initials: R
authors.lastname: Durusoy
authors.forename: Husnu
authors.initials: H
authors.lastname: Pullukcu
authors.forename: Oguz Resat
authors.initials: OR
authors.lastname: Sipahi
authors.forename: Sercan
authors.initials: S
authors.lastname: Ulusoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014421:Turkey / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*; D055815:Young Adult