OBJECTIVES: Urinary Tract Infection (UTI) was identified as the second most frequent complication at a large hospital, occurring in 3% of patients admitted, and contributing to $1.4 million in costs, during the study period October 1998 to September 1999. This project was designed to increase hospital awareness concerning UTI complication, identify patient populations at-risk, and evaluate treatments. METHODS: Risk adjustment developed at the University of Pennsylvania School of Medicine was used to predict patients' hospitalization complications. Complication rates were compared between patients with and without UTI as a secondary diagnosis. Laboratory data were analyzed to identify whether patients with a secondary diagnosis of UTI met CDC laboratory diagnosis criteria. Differentiating patients by day of onset identified potentially nosocomial UTI's. Such patients were differentiated by DRG. Finally, the distribution of antibiotic treatments was determined. RESULTS: While the predicted complication rate for patients with UTI as a secondary diagnosis was 55.0%, their actual rate was 79.2% (p<.001). 55% of such patients met CDC laboratory diagnosis criteria; of these patients, 36% were diagnosed > 3 days from admission, i.e., had potentially nosocomial UTI's. Four DRG's -- Tracheostomy, PTCA, CHF, and Hip & Knee Replacement -- accounted for 40% of all patients with UTI as a secondary diagnosis, but 80% of potentially nosocomial UTI patients. Treatment for all UTI patients showed widespread Levofloxacin use, regardless of DRG. Of note, most UTI's were related to E. Coli, which can be treated more cost-effectively with trimethoprim sulfamethoxazole. CONCLUSIONS: Based on this investigation, the hospital re-initiated the National Nosocomial Infections Surveillance System program for UTI's, evaluated Levofloxacin use, developed physician guidelines for UTI diagnosis and treatment, and increased nursing education concerning catheter care and maintenance protocols.