Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection.

Boggan, JC

Navar-Boggan, AM

Jhaveri, R

United States

2017-05-27T17:16:38Z

2017-05-27T17:16:38Z

2012-09

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.

https://www.ncbi.nlm.nih.gov/pubmed/22891227

peds.2012-0563

1098-4275

https://hdl.handle.net/10161/14592

eng

American Academy of Pediatrics (AAP)

Pediatrics

10.1542/peds.2012-0563

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

Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection.

Journal article

Boggan, JC|0000-0003-3564-2807

https://www.ncbi.nlm.nih.gov/pubmed/22891227

e615

e622

3

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

Medicine, General Internal Medicine

School of Medicine

Published

130