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

Abstract

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...