Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection.
Abstract
OBJECTIVE: Duke University Health System (DUHS) generates annual antibiograms combining
adult and pediatric data. We hypothesized significant susceptibility differences exist
for pediatric isolates and that distributing these results would alter antibiotic
choices. METHODS: Susceptibility rates for Escherichia coli isolates from patients
aged ≤12 years between July 2009 and September 2010 were compared with the 2009 DUHS
antibiogram. Pediatric attending and resident physicians answered case-based vignettes
about children aged 3 months and 12 years with urinary tract infections. Each vignette
contained 3 identical scenarios with no antibiogram, the 2009 DUHS antibiogram, and
a pediatric-specific antibiogram provided. Effective antibiotics exhibited >80% in
vitro susceptibility. Frequency of antibiotic selection was analyzed by using descriptive
statistics. RESULTS: Three hundred seventy-five pediatric isolates were identified.
Pediatric isolates were more resistant to ampicillin and trimethoprim-sulfamethoxazole
(TMP-SMX) and less resistant to amoxicillin-clavulanate and ciprofloxacin (P < .0005
for all). Seventy-five resident and attending physicians completed surveys. In infant
vignettes, physicians selected amoxicillin-clavulanate (P < .05) and nitrofurantoin
(P < .01) more often and TMP-SMX (P < .01) less often with pediatric-specific data.
Effective antibiotic choices increased from 68.6% to 82.2% (P = .06) to 92.5% (P <
.01) across scenarios. In adolescent vignettes, providers reduced TMP-SMX use from
66.2% to 42.6% to 19.0% (P < .01 for both). Effective antibiotic choices increased
from 32.4% to 57.4% to 79.4% (P < .01 and P = .01). CONCLUSIONS: Pediatric E. coli
isolates differ significantly in antimicrobial susceptibility at our institution,
particularly to frequently administered oral antibiotics. Knowledge of pediatric-specific
data altered empirical antibiotic choices in case vignettes. Care of pediatric patients
could be improved with use of a pediatric-specific antibiogram.
Type
Journal articleSubject
AdultAnti-Bacterial Agents
Child
Child, Preschool
Drug Resistance, Bacterial
Escherichia coli
Escherichia coli Infections
Female
Humans
Infant
Male
Microbial Sensitivity Tests
Urinary Tract Infections
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https://hdl.handle.net/10161/14592Published Version (Please cite this version)
10.1542/peds.2012-0563Publication Info
Boggan, JC; Navar-Boggan, AM; & Jhaveri, R (2012). Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection.
Pediatrics, 130(3). pp. e615-e622. 10.1542/peds.2012-0563. Retrieved from https://hdl.handle.net/10161/14592.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joel Boggan
Associate Professor of Medicine
I am a hospital medicine physician interested in quality improvement, patient safety,
and medical education across the UME, GME, and CME environments. My current QI and
research projects include work on readmissions, inpatient ORYX and patient experience
measures, clinical documentation improvement, medication reconciliation, and appropriate
utilization of inpatient resources. Alongside this work, I serve as the lead mentor
for our Durham VA Chief Resident in Quality and Safety within the Depart
Ann Marie Navar
Associate Professor of Medicine
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