283. Optimizing Empiric Therapy for Urinary Tract Infection in the Emergency Department
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Urinary Tract Infection (UTI) is a common presenting illness to the ED. Currently patients are treated as either community-acquired or healthcare-associated (HCA). Patients classified as having HCA-UTIs often receive broad-spectrum antibiotics with activity against Pseudomonas aeruginosa (PA)  and methicillin resistant Staphylococcus aureus (MRSA), despite a lack of data suggesting this is warranted. This study was designed to further delineate this health-care associated group.

Methods: 

A Theradoc database query was performed for all positive bacterial urine cultures during the first 48 hours of hospitalization during a 6-month period. Duplicate isolates and cultures growing vaginal colonizers were excluded. UTI’s were classified as one of the following groups: community, HCA, or nursing home. HCA patients consisted of those who presented from home and had at least 1 risk factor for a drug-resistant organism.  Antibiograms for each different patient group were created.

Results: 

The organisms isolated were similar across all groups (table 1), however the susceptibility greatly varied (table 2) and PA or MRSA were rarely isolated in any group. Among the nursing home group 27% of enterobacteriaceae were ESBL producing.

Conclusion: 

Community isolates retained susceptibility against most oral options. Third-generation cephalosporins displayed good activity in HCA isolates. Due to the large number of ESBL producing organisms, ertapenem or amikacin should be considered for nursing home patients. None of the patient groups required anti-pseudomonal or Staphylococcal coverage.

Table 1: Organism breakdown

 

Community (n=117)

Health-care associated (n =78)

Nursing Home

(n=44)

E.coli

89 (76)

41 (53)

17 (39)

K.pneumoniae

9 (8)

13 (17)

9 (20)

P.aeruginosa

1 (1)

1 (1)

2 (5)

Other Gram (-)

8 (7)

11 (14)

11 (24)

E.faecalis

5 (4)

5 (6)

2 (5)

E.faecium

0 (0)

2 (3)

2 (5)

S.aureus

4 (3)

4 (5)

1 (2)

S.epidermidis

1 (1)

1 (1)

0 (0)

Table 2: Gram (-) antibiograms

 

Drug

 

Amikacin

(%)

Cefepime

(%)

Ceftriaxone

(%)

Ciprofloxacin

(%)

Ertapenem

(%)

Gentamicin

(%)

Nitrofurantoin

(%)

SMX/TMP

(%)

Tobramycin

(%)

Community (N=107)

100

96

94

92

98

97

90

84

96

Health-care

Associated

(N=66)

99

89

86

77

97

82

67

68

89

Nursing home

(N=39)

100

69

62

41

95

76

56

56

74

 


Subject Category: A. Antimicrobial agents and Resistance

Ann Villella, PharmD1, Nitin Bhatia, PharmD1, Melissa Barton, MD1, Wasif Hafeez, MD1, Judy Moshos1, Keith Kaye, MD, MPH, FIDSA2 and Jason Pogue, PharmD2, (1)Sinai-Grace Hospital, Detroit Medical Center, Detroit, MI, (2)Detroit Medical Center (DMC) / Wayne State University, Detroit, MI

Disclosures:

A. Villella, None

N. Bhatia, None

M. Barton, None

W. Hafeez, None

J. Moshos, None

K. Kaye, None

J. Pogue, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.