Emergency Department Urinary Antibiograms Differ by Specific Patient Group

Abstract

Patients presenting to the emergency department (ED) represent a heterogeneous population comprised of all ages, various backgrounds, such as from the community and skilled-nursing facilities (SNFs), and at various risks for resistant pathogens. The aim of this study was to compare patient group-specific urinary antibiograms in the ED. Adults presented to the ED with an ICD 9/10 code urinary tract infection (UTI) diagnosis during July 2015 to June 2016 were randomly selected (<i>n</i> = 500) to extract relevant demographic, laboratory, and clinical data from the medical record. Urinary <i>Escherichia coli</i> antibiograms were compared between institutional versus ED and among ED patients (male versus female; age of 18 to 64 years versus ≥65 years; female aged 18 to 50 years versus >50 years; home versus SNF; and admitted versus discharged). <i>E. coli</i> grew from 56% (145/259) of the positive urine cultures. Overall ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (SXT), and cefazolin (CFZ) susceptibilities were <71%. Differences in antibiograms were the following: lower CFZ and SXT susceptibilities in ED versus institutional (CFZ, 67% versus 86% [<i>P</i> = 0.001]; SXT, 66% versus 74% [<i>P</i> = 0.02]), lower ampicillin and gentamicin susceptibilities in females aged 18 to 50 years versus >50 years (32% versus 52% [<i>P</i> = 0.04]; 78% versus 93% [<i>P</i> = 0.02]), lower CIP susceptibilities in the elderly (64% versus 81%; <i>P</i> = 0.03), SNF versus home (35% versus 77%; <i>P</i> < 0.001), admitted versus discharged (63% versus 78%; <i>P</i> = 0.04), and lower SXT susceptibilities in patients aged <65 years versus the elderly (58% versus 71%; <i>P</i> = 0.01). Nitrofurantoin showed >80% susceptibility in all groups. Patient group-specific urinary antibiograms revealed distinct differences in <i>E. coli</i> susceptibility and should be developed to better inform empirical UTI therapy selection in the ED.