title: Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control.
abstract: BACKGROUND
  Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control.
  
  
  METHODS
  Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one.
  
  
  RESULTS
  The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001.
  
  
  CONCLUSIONS
  Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs.
authors.affiliation: Department of Urology, Hospital of Sahloul, Sousse, Tunisia;
authors.forename: Khaireddine
authors.initials: K
authors.lastname: Bouassida
authors.affiliation: Department of Urology, Hospital of Sahloul, Sousse, Tunisia;
authors.forename: Mehdi
authors.initials: M
authors.lastname: Jaidane
authors.affiliation: Department of Microbiology, Hospital of Sahloul, Sousse, Tunisia.
authors.forename: Olfa
authors.initials: O
authors.lastname: Bouallegue
authors.affiliation: Department of Urology, Hospital of Sahloul, Sousse, Tunisia;
authors.forename: Ghassen
authors.initials: G
authors.lastname: Tlili
authors.affiliation: Department of Microbiology, Hospital of Sahloul, Sousse, Tunisia.
authors.forename: Habiba
authors.initials: H
authors.lastname: Naija
authors.affiliation: Department of Urology, Hospital of Sahloul, Sousse, Tunisia;
authors.forename: Ali Tahar
authors.initials: AT
authors.lastname: Mosbah