Enterococci are the most frequent cause of urinary tract infections (UTIs) in our hospital, which is comprised primarily of elderly male patients. Thirty of 34 UTLs, associated with enterococci in a three-month study, were preceded by urinary tract instrumentation and not related to antecedent antibiotic therapy. Although most UTLs were polymicrobic and clinically asymptomatic, monomicrobic septicemia with enterococci did occur and in one patient polymicrobic bacteremia was observed. Extensive epidemiologic studies demonstrated that the mode of spread did not involve passive carriage by personnel or other exogenous sources. Rather endogenous infection with the patient's fecal flora serving as the reservoir was probably responsible for the UTLs. This route of spread was demonstrated prospectively in two patients. Proper and frequent cleansing of the perineal area after catheter insertion should decrease UTIs resulting from this endogenous route.
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