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Hospital data may provide misinformation for resistance patterns in UTIs
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Antibiograms drawn from hospital-based laboratory data may offer inaccurate information regarding antibiotic resistance patterns for ambulatory pediatric patients with urinary tract infections, according to study results published in the Journal of thePediatric Infectious Diseases Society.
Prior studies have reported that broader-spectrum antibiotics are prescribed one-third of the time for ambulatory pediatric UTI. Although pediatric UTI is a problem commonly managed in the outpatient setting, antibiotic selection is predominantly derived from inpatient data — therefore, hospital antibiograms could indicate disparate resistance rates than those that exist among ambulatory patients.
“Although the spectrum and antimicrobial susceptibility of a variety of pediatric uropathogens have been well characterized in the literature, no studies have compared antibiogram data about uropathogens derived exclusively from ambulatory pediatric patients with traditional hospital-based antibiograms,” Per Hans Gesteland, MD, MSc, of the division of pediatric inpatient medicine from the University of Utah, and colleagues wrote.
To compare the spectrum and antimicrobial susceptibility, Gesteland and colleagues conducted a retrospective cross-sectional study of positive urine cultures obtained from pediatric patients admitted to hospitals (n=5) and ambulatory clinics (n=32).
The researchers performed statistical comparisons of antimicrobial susceptibility using Fisher’s exact test. A two-tailed P value of <.05 was considered statistically significant and, after consulting with hospital-based pediatric infectious disease physicians, the researchers set the threshold for clinical significance at ≥10% difference in antimicrobial susceptibility.
According to study results, Escherichia coli accounted for a larger percentage of observed bacterial isolates obtained from urine samples and were more susceptible to narrower-spectrum antibiotics, indicating the potential need for ambulatory pediatric antibiograms.
The researchers found that differences between ambulatory and hospital susceptibility for common antimicrobials, such as ampicillin (54.6% vs. 38.8%), cephalothin (54.8% vs. 27.8%) and cefuroxime (98.3% vs. 55.6%), were clinically and statistically significant.
“Ideally, clinicians will have access to computerized provider order entry, coupled with clinical decision support systems that take advantage of regional resistance data and the specific patient’s clinical condition and setting to provide targeted treatment recommendations,” Gesteland and colleagues wrote. “Until such systems are ubiquitous in practice, we should be striving to provide clinicians with community-level antibiograms tailored to specific populations and conditions.”
Disclosure: The researchers reported no relevant financial disclosures.
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