Electronic prediction tool superior to physician for empiric selection of UTI treatment

New research found that an electronic tool that uses clinical risk factors and collective antibiotic resistance data to predict which antibiotic regimen will best treat organisms causing urinary tract infections was significantly better at empiric selection of antibiotic than an antibiotic stewardship physician.

The results regarding this electronic prediction tool, known as the Weighted Incidence Syndromic Combination Antibiogram, or WISCA, were recently presented by Kamaljit Singh, MD, from the Northshore University Health System, at the Society for Healthcare Epidemiology of America spring conference.

Researchers used the WISCA tool on inpatients with urinary tract infections (UTIs) at the 750-bed Northshore University Health System in Evanston, Illinois, from July 13, 2015, to Feb. 18, 2016. They compared empiric antibiotic selection using WISCA and recommendations by an antibiotic stewardship physician with the results of final urine cultures among patients with UTIs. If the infecting organism was susceptible to the chosen agent based on in vitro antibiotic susceptibility testing, they considered the antibiotic selection effective.

Out of 414 cases included in the study, the most commonly isolated pathogens were Escherichia coli (53%), Klebsiella pneumoniae (13%), Enterococcus faecalis (7.7%), Proteus mirabilis (5.3%) and Pseudomonas aeruginosa (3.4%). Singh and colleagues found that WISCA chose an effective antibiotic in 95.2% of cases compared with 84.7% by antibiotic stewardship physician (P < .005). The top antibiotics recommended by antibiotic stewardship physicians were ceftriaxone, piperacillin-tazobactam and ciprofloxacin, whereas WISCA most commonly recommended PTZ plus linezolid, meropenem plus vancomycin and meropenem plus linezolid. The antibiotic stewardship physician agreed with WISCAs top pick in only 2.5% of cases. The researchers observed that the physician most frequently selected the ineffective drug–bug combination of ceftriaxone for E. faecalis (28.6%), and that there were more multidrug-resistant organisms in this group including extended-spectrum beta-lactamase-producing bacteria, vancomycin-resistant enterococci and MRSA. However, the authors also stress that WISCA selects a much broader empiric antibiotic regimen than the stewardship physician without clear clinical outcome benefits. – by Savannah Demko

Reference:

Singh K, et al. Electronic Prescribing Tool versus Antibiotic Stewardship Physician for Treatment of Urinary Tract Infections. Presented at: Society for Healthcare Epidemiology of America spring conference; March 29-31, 2017; St. Louis.

Disclosure: Singh reports no relevant financial disclosures.