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Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection.

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48.3 Kb
Date
2012-09
Authors
Boggan, JC
Navar-Boggan, AM
Jhaveri, R
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115
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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 article
Subject
Adult
Anti-Bacterial Agents
Child
Child, Preschool
Drug Resistance, Bacterial
Escherichia coli
Escherichia coli Infections
Female
Humans
Infant
Male
Microbial Sensitivity Tests
Urinary Tract Infections
Permalink
https://hdl.handle.net/10161/14592
Published Version (Please cite this version)
10.1542/peds.2012-0563
Publication 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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Scholars@Duke

Boggan

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
Navar

Ann Marie Navar

Associate Professor of Medicine
Alphabetical list of authors with Scholars@Duke profiles.
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