Sensitivity of urinary pathogens for patients discharged from the emergency department compared with the hospital antibiogram

Abstract

Background Data for hospital antibiograms are typically compiled from all patients, regardless of disposition, demographics and other comorbidities. Objective We hypothesized that the sensitivity patterns for urinary pathogens would differ significantly from the hospital antibiogram in patients that were discharged from the emergency department (ED). Methods We evaluated a retrospective cohort of all adult patients with positive urine cultures treated in the 2016 calendar year at an inner-city academic ED. Positive urine cultures defined by our institution’s microbiology department. Investigators conducted a structured review of an electronic medical record (EMR) to collect demographic, historical and microbiology records. We utilized a one-sample test of proportion to compare the sensitivity of each organism for discharged patients to the hospital published antibiogram. Alpha set at 0.05. Results During the study period, 414 patients were discharged from the ED and found to have positive urine cultures; 20% age > 60 years old, 85% female, 79% Hispanic, 33% diabetic. The most common organisms was E. coli (78%). E. coli was sensitive to Trimethoprim-Sulfamethoxazole for 59% vs. 58% in our antibiogram ( p = 0.77), Ciprofloxacin 81% vs. 69% ( p < 0. 001), Nitrofurantoin 96% vs 95%; ( p = 0.25). K. pneumoniae was sensitive to Trimethoprim-Sulfamethoxazole 87% vs. 80% in our antibiogram ( p = 0.26), Ciprofloxacin 100% vs. 92% ( p = 0.077), Nitrofurantoin 86% vs 41% ( p < 0.001). Conclusions For our predominantly Hispanic study group with a high prevalence of diabetes, we found that our hospital antibiogram had relatively good value in guiding antibiotic therapy though for some organism/antibiotic combinations sensitivities were higher than expected.

<p>Prevalence of Common Nosocomial Infections and Evaluation of Antibiotic Resistance Patterns in Patients with Secondary Infections in Hamadan, Iran</p>

“…The prevalence of antibiotic resistance in gram-positive S. aureus and S. epidermidis was lower than in gram-negative bacteria. The results of Carlsen et al, 31 study on the susceptibility of urinary pathogens causing NIs showed that the highest antibiotic susceptibility to ciprofloxacin and nitrofurantoin was observed in E. coli and K. pneumoniae isolates, respectively and these results are consistent with our findings. In the present study, the more number of antibiotics were investigated, and there was a higher antibiotic susceptibility in some studied antibiotics such as nitrofurantoin, ampicillin, clindamycin, linezolid, penicillin G, oxacillin, piperacillin, and tobramycin.…”

“…In our research Klebsiella and E. coli isolates susceptibility to co-trimoxazole are in contrast in UTI samples so that the resistance rate for Klebsiella and E.coli was 1 (0.7%) and 444 (53%) against co-trimoxazole are the minimum and maximum resistance to co-trimoxazole respectively. 31 This finding of Klebsiella is in contrast with the Sakkas H study in 2019 32 that reported the prevalence of co-trimoxazole resistant bacteria 95%. This difference may be due to the different geographical region and so in our region, the pattern of antibacterial resistance of klebsiella to cotrimoxazole is different from other areas significantly.…”

Which patient should start empirical antibiotic treatment in urinary tract infection in emergency departments?

“…reported a higher frequency of diabetes in their retrospective, cross-sectional study. [ 13 ] In a retrospective case–control study, Lee et al . found that diabetes and cerebrovascular disease were more frequent than other comorbid conditions in 150 patients with positive urine cultures.…”

Antibiotic resistance in urinary tract infections: A re-visit after five years and experience over two sites

“…E. coli as the primary causative agent in UTI has been well established. Reported rates are around 60% in England 34 and up to 80% in Europe 35–37 this is likely because it is the most prevalent bacteria in the human gastro-intestinal tract. 38 The proximity of the anus to the urinary tract allows passage of the bacteria which can become pathological.…”