Development of a urinary-specific antibiogram for gram-negative isolates: Impact of patient risk factors on susceptibility
| Autor: | Michael Costello, Sarah M. Wieczorkiewicz, Ina Zamfirova, Nicole Rabs |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Epidemiology Klebsiella pneumoniae Urinary system Microbial Sensitivity Tests medicine.disease_cause Microbiology Young Adult Antibiotic resistance Risk Factors Internal medicine Gram-Negative Bacteria Humans Medicine Child Aged Retrospective Studies Gram Aged 80 and over biology business.industry Pseudomonas aeruginosa Health Policy Infant Newborn Public Health Environmental and Occupational Health Infant Middle Aged biology.organism_classification Antimicrobial Proteus mirabilis Anti-Bacterial Agents Infectious Diseases Child Preschool Urinary Tract Infections Female Gram-Negative Bacterial Infections business Empiric therapy |
| Zdroj: | American Journal of Infection Control. 42:393-400 |
| ISSN: | 0196-6553 |
| DOI: | 10.1016/j.ajic.2013.11.004 |
| Popis: | Background Traditional antibiograms guide clinicians in selecting appropriate empiric antimicrobials, but they lack data on syndrome/disease-specific susceptibility, isolate location, polymicrobial infections, and patient risk factors. The aim of this study was to develop a urinary-specific antibiogram and to evaluate the impact of risk factors on antimicrobial susceptibility. Methods This retrospective descriptive study used culture and susceptibility data from January 1 to December 31, 2012. A urinary antibiogram specific for Escherichia coli (EC) , Proteus mirabilis (PM), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA) was developed. Urinary and standard antibiogram susceptibilities were compared. Urinary isolates were then stratified by risk factors—residence before admission, age, systemic antimicrobial use for ≤30 days, hospitalization for ≤30 days, and hospital unit—to determine the impact on antimicrobial susceptibility. Results There were 2,284 urinary isolate encounters. Overall antimicrobial susceptibility was increased, and the prevalence of extended-spectrum β-lactamase–producing isolates was significantly greater (KP, 14% vs 7% [ P = .001]; EC, 13% vs 9% [ P P = .004]) in the urinary antibiogram vs the standard antibiogram. Health care facility residence had the greatest impact on susceptibility for all urinary isolates, especially on fluoroquinolone susceptibility for EC and PM. Conclusions Using a syndromic antibiogram and incorporating patient risk factors into susceptibility data may be more useful in guiding clinicians in selecting more appropriate empiric therapy. |
| Databáze: | OpenAIRE |
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