Clinical Value of an Ambulatory-Based Antibiogram for Uropathogens in Children: Table 1.

Dahle, Kevin W.; Korgenski, E. Kent; Hersh, Adam L.; Srivastava, Rajendu; Gesteland, Per H.

doi:10.1093/jpids/pis055

Cited by 32 publications

(28 citation statements)

References 9 publications

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“…10,11 Dahle et al recently examined different susceptibility patterns of urinary isolates in a single health care system, comparing a community based uropathogen antibiogram to a hospital based uropathogen antibiogram for children in Utah. 5 Similar to our findings, they determined that there was a difference in resistance patterns between outpatient and inpatient uropathogens. We evaluated whether outpatient vs inpatient resistance patterns would follow similar trends on a larger, broader scale.…”

Section: Discussionsupporting

confidence: 89%

“…Our findings extend what was previously found in single center studies. 5,9 The different resistance patterns in outpatient and inpatient settings affect empirical antibiotic choices when treating a child with a UTI. Clinicians must choose an antibiotic with a high likelihood of coverage while considering potential adverse effects and minimizing unnecessary overuse of broadspectrum antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital based laboratory data combine outpatient and inpatient sensitivity and resistance patterns to generate antibiograms for empirical antibiotic prescribing and yet these data may not accurately reflect uropathogen resistance patterns in outpatients. 3,5,6 Studies from single centers show that antibiotic resistance patterns for pediatric UTI differ by setting with generally higher resistance rates among inpatients than outpatients. Based on these findings these studies suggest that antibiograms should separate data on outpatients from those on inpatients to maximize the usefulness of antibiograms for empirical antibiotic selection for UTI treatment.…”

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confidence: 99%

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643 a Comparison of Inpatient Versus Outpatient Resistance Patterns in Pediatric Urinary Tract Infection

Saperston¹,

Shapiro

Hersh³

et al. 2013

Journal of Urology

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Purpose-Prior single center studies showed that antibiotic resistance patterns differ between outpatients and inpatients. We compared antibiotic resistance patterns for urinary tract infection between outpatients and inpatients on a national level.Materials and Methods-We examined outpatient and inpatient urinary isolates from children younger than 18 years using The Surveillance Network (Eurofins Scientific, Luxembourg, Luxembourg), a database of antibiotic susceptibility results, as well as patient demographic data from 195 American hospitals. We determined the prevalence and antibiotic resistance patterns of the 6 most common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for outpatient and inpatient isolates using chisquare analysis.Results-We identified 25,418 outpatient (86% female) and 5,560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall but its prevalence varied by gender and visit setting, that is 79% of uropathogens overall for outpatient isolates, including 83% of females and 50% of males, compared to 54% for overall inpatient isolates, including 64% of females and 37% of males (p <0.001). Uropathogen resistance to many antibiotics was lower in the outpatient vs inpatient setting, including trimethoprim/ sulfamethoxazole 24% vs 30% and cephalothin 16% vs 22% for E. coli (each p <0.001), cephalothin 7% vs 14% for Klebsiella (p = 0.03), ceftriaxone 12% vs 24% and ceftazidime 15% vs 33% for Enterobacter (each p <0.001), and ampicillin 3% vs 13% and ciprofloxacin 5% vs 12% for Enterococcus (each p <0.001).Conclusions-Uropathogen resistance rates of several antibiotics are higher for urinary specimens obtained from inpatients vs outpatients. Separate outpatient vs inpatient based antibiograms can aid in empirical prescribing for pediatric urinary tract infections. Antibiotic resistance in pediatric patients is increasing. [1][2][3] Fewer than 50% of all pediatric UTIs are susceptible to commonly used antibiotics. 4 Because identification and susceptibilities are not available at the point of care, antibiograms are useful aids for empirical treatment of UTI while cultures are pending. Hospital based laboratory data combine outpatient and inpatient sensitivity and resistance patterns to generate antibiograms for empirical antibiotic prescribing and yet these data may not accurately reflect uropathogen resistance patterns in outpatients. 3,5,6 Studies from single centers show that antibiotic resistance patterns for pediatric UTI differ by setting with generally higher resistance rates among inpatients than outpatients. Based on these findings these studies suggest that antibiograms should separate data on outpatients from those on inpatients to maximize the usefulness of antibiograms for empirical antibiotic selection for UTI treatment. To our knowledge the extent to which these differences in resis...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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643 a Comparison of Inpatient Versus Outpatient Resistance Patterns in Pediatric Urinary Tract Infection

Saperston¹,

Shapiro

Hersh³

et al. 2013

Journal of Urology

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“…19 Moreover, most antibiograms are from hospital based laboratory data, and a recent study from Dahle et al showed that these data may provide inaccurate information about antibiotic resistance patterns for ambulatory pediatric patients. 20 Thus, the goal should be to promote separate institutional guidelines for hospital and community based patients derived from local data to optimize empirical prescribing choices and reduce the use of unnecessarily broad agents or antibiotics with known higher resistance rates.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Resistance Patterns of Outpatient Pediatric Urinary Tract Infections

et al. 2013

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Purpose We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. Materials and Methods We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. Results We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p <0.001). Other common species among males were Enterococcus (17%), P. mirabilis (11%) and Klebsiella (10%). However, these uropathogens each accounted for 5% or less of female isolates (p <0.001). Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). Conclusions E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment.

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“…While no additional resources are required to separate results based on patient age, hospitals often combine susceptibility data for adults and children. Dahle and colleagues demonstrated differences between inpatient and outpatient resistance patterns and recommended separate antibiograms by visit setting [Dahle et al 2012]. In a recent study (unpublished data), inpatient and outpatient urinary isolates from children under 18 years were examined using The Surveillance Network, and compared 25,418 outpatient and 5560 inpatient urinary isolates.…”

Section: Improving Antibiotic Prescribing Patternsmentioning

confidence: 99%

Antibiotic resistance in pediatric urology

Edlin

Copp

2013

Therapeutic Advances in Urology

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Antibiotics are a mainstay in the treatment of bacterial infections, though their use is a primary risk factor for the development of antibiotic resistance. Antibiotic resistance is a growing problem in pediatric urology as demonstrated by increased uropathogen resistance. Lack of urine testing, nonselective use of prophylaxis, and poor empiric prescribing practices exacerbate this problem. This article reviews antibiotic utilization in pediatric urology with emphasis on modifiable practice patterns to potentially help mitigate the growing rates of antibiotic resistance. This includes urine testing to only treat when indicated and tailor broadspectrum therapy as able; selective application of antibiotic prophylaxis to patients with highgrade vesicoureteral reflux and hydronephrosis with counseling regarding the importance of compliance; and using local antiobiograms, particularly pediatric-specific antiobiograms, with inpatient versus outpatient data.

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Clinical Value of an Ambulatory-Based Antibiogram for Uropathogens in Children: Table 1.

Cited by 32 publications

References 9 publications

643 a Comparison of Inpatient Versus Outpatient Resistance Patterns in Pediatric Urinary Tract Infection

643 a Comparison of Inpatient Versus Outpatient Resistance Patterns in Pediatric Urinary Tract Infection

Antibiotic Resistance Patterns of Outpatient Pediatric Urinary Tract Infections

Antibiotic resistance in pediatric urology

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