Downward Trends in Surgical Site and Urinary Tract Infections After Cesarean Delivery in a French Surveillance Network, 1997–2003

2008 ◽  
Vol 29 (3) ◽  
pp. 227-233 ◽  
Author(s):  
Agnès Vincent ◽  
Louis Ayzac ◽  
Raphaële Girard ◽  
Emmanuelle Caillat-Vallet ◽  
Catherine Chapuis ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Urinary Tract ◽  
Cesarean Delivery ◽  
National Standards ◽  
Healthcare Associated Infection ◽  
Odds Ratios ◽  
Surveillance Network ◽  
Maternal Risk ◽  
Preventive Practices ◽  
Tract Infections

Objective.To evaluate whether the adjusted rates of surgical site infection (SSI) and urinary tract infection (UTI) after cesarean delivery decrease in maternity units that perform active healthcare-associated infection surveillance.Design.Trend analysis by means of multiple logistic regression.Setting.A total of 80 maternity units participating in the Mater Sud-Est surveillance network.Patients.A total of 37,074 cesarean deliveries were included in the surveillance from January 1, 1997, through December 31, 2003.Methods.We used a logistic regression model to estimate risk-adjusted post–cesarean delivery infection odds ratios. The variables included were the maternity units' annual rate of operative procedures, the level of dispensed neonatal care, the year of delivery, maternal risk factors, and the characteristics of cesarean delivery. The trend of risk-adjusted odds ratios for SSI and UTI during the study period was studied by linear regression.Results.The crude rates of SSI and UTI after cesarean delivery were 1.5% (571 of 37,074 patients) and 1.8% (685 of 37,074 patients), respectively. During the study period, the decrease in SSI and UTI adjusted odds ratios was statistically significant (R = −0.823 [P = .023] and R = −0.906 [P = .005], respectively).Conclusion.Reductions of 48% in the SSI rate and 52% in the UTI rate were observed in the maternity units. These unbiased trends could be related to progress in preventive practices as a result of the increased dissemination of national standards and a collaborative surveillance with benchmarking of rates.

scholarly journals Reducing the Use of Indwelling Urinary Catheters During Cesarean Deliveries

2017 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Michelle Borland
Keyword(s):  
Urinary Tract ◽  
Needs Assessment ◽  
Cesarean Delivery ◽  
Small Community ◽  
Urinary Catheters ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
Cesarean Deliveries ◽  
Increased Risk ◽  
Tract Infections

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee’s models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries. Key words: Indwelling catheter, Urinary catheter, Foley, Cesarean, C-section

scholarly journals Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022137 ◽  
Author(s):  
Allison S Letica-Kriegel ◽  
Hojjat Salmasian ◽  
David K Vawdrey ◽  
Brett E Youngerman ◽  
Robert A Green ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Large Data ◽  
Time Range ◽  
Healthcare Associated Infection ◽  
Cross Sectional ◽  
Data Set ◽  
Paediatric Hospital ◽  
Tract Infections

MotivationCatheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities.ObjectiveTo examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities.DesignRetrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time.SettingUrban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital.ResultsThe study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%–1.65% in the 10–60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI.ConclusionsUsing a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.

scholarly journals Uropathogens and Gestational Outcomes of Urinary Tract Infections in Pregnancies that Necessitate Hospitalization

2019 ◽  
Vol 13 (2) ◽  
pp. 70-73 ◽  
Author(s):  
Alp Tuna Beksac ◽  
Gokcen Orgul ◽  
Atakan Tanacan ◽  
Hasan Uckan ◽  
Banu Sancak ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Analysis ◽  
Klebsiella Pneumonia ◽  
Medical Treatments ◽  
Maternal Risk ◽  
Antimicrobial Susceptibility Tests ◽  
Gestational Week ◽  
Susceptibility Tests ◽  
Tract Infections

Background and Objectives: Our aim is to identify uropathogens that cause urinary tract infections (UTIs) that necessitate hospitalization, and analyze outcomes of gestational UTIs. Methods: This study consisted of 30 pregnant women who necessitate hospitalization because of UTI (7.8% of gestational UTIs during the same period of time). UTI that necessitates hospitalization is defined as clinical complaints, urination problems, urine analysis and culture positivity, fever and uterine discomfort. Patients with at least two positive cultures (≥ 100,000 cfu/ml) were included to this study. Antimicrobial susceptibility tests were obtained in all cases in order to determine antimicrobial resistance and to choose the ideal antibiotics for treatment. Results: In our study, we have found that Escherichia coli is the most common microorganism (56.7%). Enterococcus faecalis (13.3%) and Klebsiella pneumonia (10%) were other frequently observed microorganisms. In this series, mean gestational week at birth was 35 weeks 5 days (range 23-40 weeks). Mean birthweight was 2,656 g (range 500-3,700 g). Twenty-three cases (76.7%) were hospitalized before 37th gestational week and preterm delivery rate was 56.3%. Maternal risk factors and coexisting diseases were detected in 11 (36.7%) patients as follows: diabetes mellitus in 4, thrombophilia in 3, thyroid disorders in 3 and hydroureteronephrosis in 1 case. Cesarean section rate was 65.2%. Conclusions: Knowing uropathogens of patient population is beneficial in the management of patients and better planning of future medical treatments. Preterm labor seems to be an important complication in pregnancies with UTIs going together with fever and urination problems.

scholarly journals Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic

2021 ◽  
Vol 58 ◽  
pp. 004695802110679
Author(s):  
Hela Ghali ◽  
Asma Ben Cheikh ◽  
Sana Bhiri ◽  
Selwa Khefacha ◽  
Houyem Said Latiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Protective Factor ◽  
Bloodstream Infections ◽  
Point Prevalence ◽  
University Hospital ◽  
Healthcare Associated Infection ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Background Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Aim To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. Methods The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. Results Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% ( P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). Conclusion Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

scholarly journals Access to sanitation and risk of developing urinary tract infections among women from low socio-economic settings

2019 ◽  
Vol 6 (7) ◽  
pp. 2939
Author(s):  
Rama Kawade ◽  
Anjali Radkar ◽  
Abhilash Thadathil ◽  
Deepa Thakur
Keyword(s):  
Logistic Regression ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
Cross Sectional ◽  
Younger Women ◽  
Increased Risk ◽  
Restricted Use ◽  
Tract Infections

Background: Poor sanitation facilities are root cause of many health problems of people residing in slums. The present study estimates the prevalence of urinary tract infections (UTI) and identifies factors associated with an increased risk of UTI among women.Methods: A cross-sectional study was conducted among 616 women aged between 18 to 60 years residing in 33 slums across four cities in Maharashtra, India. Data related to individual characteristics of women, housing condition, access to sanitation facilities, behaviors adopted by the women that could lead to UTI and an episode of symptomatic UTI in the previous one month were recorded through structured questionnaire. Logistic regression analysis was performed to find out risk factors for UTI among women.Results: The prevalence of UTI was found to be 19.6%. The prevalence was higher among young women aged upto 30 years (23.2%). In absence of individual toilet, women had adopted certain behaviors such as urine holding (21.3%), modify dinner to avoid toilet use at night (26.6%) and avoid intake of liquids (10.7%) to reduce frequency of visits to toilet. All these behaviors were significantly associated with UTI. Multiple logistic regression indicated that UTI was strongly and independently associated with age (OR=1.64, 95%CI: 1.08, 2.47), no access to bathroom (OR=2.21, 95%CI: 1.08, 4.49) and avoid intake of liquids (OR=2.70, 95%CI: 1.53, 4.75) (p<0.05).Conclusions:Behavior modifications by women to adjust with restricted use of place of urination may affect their health and increase the likelihood of developing UTI. Younger women are more at risk of developing UTI.  

scholarly journals 1436. Comparison of Ceftazidime–Avibactam, Ceftolozane–Tazobactam, Piperacillin–Tazobactam, and Meropenem Activities When Tested Against Gram-Negative Organisms Isolated From Complicated Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S524-S524
Author(s):  
Helio S Sader ◽  
Robert K Flamm ◽  
Mariana Castanheira ◽  
Rodrigo E Mendes
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Activities ◽  
Healthcare Associated Infection ◽  
Gram Negative ◽  
Highly Active ◽  
The Us ◽  
Gram Negative Organisms ◽  
Tract Infections ◽  
Esbl Producers

Abstract Background Complicated urinary tract infections (cUTIs) represent a major cause of healthcare-associated infection and a major source of gram-negative (GN) bacteremia. We evaluated the antimicrobial activities of recently approved β-lactamase inhibitor combinations and comparators against GN bacteria isolated from patients with cUTIs in the US hospitals in 2018. Methods Unique patient isolates were consecutively collected from patients with cUTIs in 65 hospitals in 2018, and the GN organisms (n = 4,371) were susceptibility (S) tested by reference broth microdilution methods. Enterobacterales (ENT) with elevated cephalosporin MICs were screened for β-lactamase-encoding genes by whole-genome sequencing. Results The most common GN organisms were E. coli (44.5%), K. pneumoniae (19.6%), P. mirabilis (6.7%), and P. aeruginosa (PSA; 5.3%). The most active agents against ENT were ceftazidime–avibactam (CAZ-AVI; 99.9%S), amikacin (AMK; 99.7%S), and meropenem (MEM; 99.4%S; table). Extended-spectrum β-lactamase (ESBL) genes were identified in 315 ENT (7.6%; excluding carbapenemase co-producers), including CTX-M-15 (63% of ESBL producers), other CTX-M types (25%), OXA-1/OXA-30 (39%), and SHV type (30%); approximately 50% of ESBL producers had ≥2 ESBL genes, mainly a CTX-M-type and an OXA-type (37% of isolates). The most active agents against ESBL producers were CAZ-AVI (100.0%S), AMK (99.7%S), and MEM (99.4%S); whereas ceftolozane–tazobactam (C-T) and piperacillin–tazobactam (PIP-TAZ) were active against 90.6% and 84.8% of ESBL producers, respectively. Only CAZ-AVI (87.0%S), colistin (COL; 87.0%S), and tigecycline (95.7%S) exhibited good activity against carbapenem-resistant ENT (CRE). Only 3 ENT isolates (0.07%) were CAZ-AVI resistant and all had a metallo-β-lactamase gene (2 VIM-1 and 1 NDM-1). CAZ-AVI (97.0%S) and C-T (99.1%S) were the most active β-lactams tested against PSA; other compounds with > 90%S for PSA were COL (99.6%), AMK (97.8%), tobramycin (93.5%), and CAZ (90.4%). Conclusion CAZ-AVI was highly active against a large collection of contemporary GN bacteria isolated from patients with cUTIs in US hospitals and provided greater coverage than the agents currently available in the US to treat cUTIs. Disclosures All authors: No reported disclosures.

Using evidence-based guidelines to reduce catheter related urinary tract infections in England

2009 ◽  
Vol 10 (2) ◽  
pp. 44-48 ◽  
Author(s):  
Carol Pellowe
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Guideline Implementation ◽  
Evidence Base ◽  
Control Programme ◽  
Control Measures ◽  
Healthcare Associated Infection ◽  
National Guidelines ◽  
Prevention And Control Measures ◽  
Tract Infections

Acquiring a healthcare associated infection (HCAI) in hospital remains a significant threat to patient safety, and catheter associated urinary tract infections (CAUTI) account for the majority of these infections. This review focuses on the complementary and continuing influence of central policy, evidence for practice, and educational support on strategies to reduce the incidence of CAUTI in the National Health Service (NHS). The development of the Department of Health's (DH) national guidelines for preventing HCAI (the `epic' guidelines) (Pratt et al, 2001, 2007) became the evidence base for the development of the DH Saving Lives strategy (DH, 2007). This initiative provides the tools and resources for NHS trusts to embed clinically effective HCAI prevention and control measures into everyday practice that are applied consistently to everyone. The national guidelines are also providing the evidence base for various educational initiatives designed to support guideline implementation, including the NHS Core Learning Unit's (CLU) Infection Control Programme.

scholarly journals 794. Healthcare-Associated Urinary Tract Infection (HA-UTI): A Risk Factor for Clostridioides difficile Infection (CDI)? Results of a Real-World Data Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S440-S441
Author(s):  
Timothy Kelly ◽  
Timothy Kelly ◽  
ChinEn Ai ◽  
ChinEn Ai ◽  
John Murray ◽  
...  
Keyword(s):  
Risk Factor ◽  
Data Analysis ◽  
Urinary Tract ◽  
Real World ◽  
Healthcare Associated Infection ◽  
Real World Data ◽  
World Data ◽  
Increased Risk ◽  
Tract Infections ◽  
Healthcare Associated

Abstract Background It is estimated that 223,900 cases of CDI occur annually in hospitalized patients resulting in 12,800 deaths and $1 billion in attributable costs. Antimicrobial use is a risk factor for CDI and the antimicrobials ordered to treat urinary tract infections have been identified as a factor in both recurrent CDI and community-acquired CDI. This real-world data analysis seeks to explore the relationship between HA-UTI and hospital-onset CDI (HO-CDI). Methods An electronic infection surveillance system was the source of de-identified real-world data from 290 hospitals. Algorithmically-derived measures of healthcare-associated infections (ADM-HAIs), and records of all-cause antimicrobial orders, for all inpatient admissions for the period 10/1/18–9/30/19 were analyzed. All patients who presented with a urine ADM-HAI – suggestive of HA-UTI – and no other healthcare-associated infection (Urine+ patients), were observed for subsequent HO-CDI. Urine+ patients were compared to patients with no HAI of any type, other than CDI (HAI-free patients), and relative risk (RR) was estimated. The analysis was repeated for the subgroup of patients who received an antimicrobial order for any reason during their stay. Results 3,050,525 inpatient admissions were analyzed. 26,634 were identified as Urine+ patients. 188 of those patients subsequently presented with HO-CDI. 2,978,507 were identified as HAI-free patients. 6,238 of those patients presented with HO-CDI. The incidence of HO-CDI was significantly higher in Urine+ patients compared to HAI-free patients (RR=3.37, 95% CL[2.92, 3.89], p&lt; 0.0001). When the analysis was repeated to examine only patients who received antimicrobial orders, Urine+ patients continued to be at higher risk of subsequent HO-CDI compared to HAI-free patients (RR=3.28, 95% CL[2.74,3.92], p&lt; 0.0001). Conclusion The presence of a urine ADM-HAI, suggestive of HA-UTI, was associated with an increased risk of subsequent HO-CDI. This held when only patients with antimicrobial orders were considered. These observations mirror findings from other published studies, however, other factors may have contributed to increased risk for both HA-UTI and HO-CDI. Disclosures Timothy Kelly, MS, MBA, BD (Employee) ChinEn Ai, MPH, BD (Employee) John Murray, MPH, BD (Employee) Yan Xiong, n/a, BD (Becton Dickinson) (Employee) Hanna Jokinen-Gordon, PhD, BD (Employee)

scholarly journals Maternal serum zinc levels and urinary tract infections among pregnant women at a tertiary hospital in Lusaka, Zambia: a cross-sectional study

2021 ◽  
Vol 10 (9) ◽  
pp. 1062
Author(s):  
John Musaba ◽  
Moses Mukosha ◽  
Lubinda Mukololo ◽  
Bellington Vwalika
Keyword(s):  
Logistic Regression ◽  
Urinary Tract ◽  
Pregnant Women ◽  
Serum Zinc ◽  
Cross Sectional Study ◽  
Maternal Serum ◽  
Sectional Study ◽  
Cross Sectional ◽  
Serum Zn ◽  
Tract Infections

Background: Micronutrient deficiency is one of the leading public health problems, particularly in lower-middle-income countries. The link between serum zinc (Zn) levels and urinary tract infections (UTIs) among pregnant women is still poorly understood. We investigated the association between maternal serum Zn levels and UTIs among pregnant women at women and newborn hospital in Lusaka, Zambia.Methods: We conducted an analytical cross-sectional study among 228 pregnant women aged 18 to 45 years between 1 September and 30 November 2019. Serum Zn levels were measured using atomic absorption spectrophotometry (AAS), whereas UTIs were determined based on the local hospital guidelines. We used the logistic regression model to determine the association between Zn levels and UTIs. The analysis was done at a significance level of 5% and 95% confidence interval.Results: Of the total participants, 118/228 (51.75%) tested positive for UTIs from urine culture. The mean serum Zn levels in the group diagnosed with UTIs were 53.95 ug/dl (SD=35.10), while in those who had no UTIs, it was 50.05 ug/dl (SD=35.10). In a multivariable logistic regression analysis, we found no evidence of an association between serum Zn levels and UTIs (p=0.435).Conclusions: From the study findings, there was no association between serum Zn levels and UTIs. This result suggests that Zn may not have any role in urinary tract infection. Nevertheless, more extensive studies are needed to confirm our findings.

Secular Trends in Gram-Negative Resistance among Urinary Tract Infection Hospitalizations in the United States, 2000–2009

2013 ◽  
Vol 34 (9) ◽  
pp. 940-946 ◽  
Author(s):  
Marya D. Zilberberg ◽  
Andrew F. Shorr
Keyword(s):  
United States ◽  
Urinary Tract ◽  
The United States ◽  
Secular Trends ◽  
Hospitalized Patients ◽  
Resistance Pattern ◽  
Surveillance Network ◽  
Gram Negative ◽  
Nationwide Inpatient Sample Database ◽  
Tract Infections

Objective.Urinary tract infections (UTIs) are common among hospitalized patients. Selection of an appropriate antibiotic for this infection requires knowledge of both its general microbiology and the epidemiology of drug-resistant organisms. We sought to determine secular trends in UTI hospitalizations that involve gram-negative (GN) multidrug-resistant Pseudomonas aeruginosa (MDR-PA), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae(KP), and carbapenem-resistant Enterobacteriaceae (CRE).Design.Survey.Patients.Patients with UTI in US hospitals between 2000 and 2009.Methods.We first derived the total number of UTI hospitalizations in the United States from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database years 2000–2009. Based on a literature review, we then determined what proportion of all UTIs arise due to each of the organisms of interest, irrespective of resistance pattern. Finally, we assessed the prevalence of resistance within each pathogen based on the Eurofins Surveillance Network database 2000–2009. Susceptibility patterns served as phenotypic surrogates for resistance.Results.Between 2000 and 2009, the frequency of UTI hospitalizations increased by approximately 50%, from 53 to 77 cases per 1,000 hospitalizations. Infections due to all GN bacteria followed a similar trajectory, whereas those caused by resistant GN pathogens increased by approximately 50% (MDR-PA) to approximately 300% (ESBL). CRE emerged and reached 0.5 cases per 1,000 hospitalizations in this 10-year period.Conclusions.The epidemiology and microbiology of GN UTI hospitalizations has shifted over the past decade. The proportion of all hospitalizations involving this infection has climbed. Resistant GN bacteria are becoming more prevalent and are implicated in an increasing proportion of UTIs among hospitalized patients.

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