253. “What is the local resistance rate of uropathogens causing acute uncomplicated cystitis? A comparison of resistance rates by different reporting methods”
Session: Poster Abstract Session: Diagnostic Microbiology; Antimicrobial Sensitivities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Nuntra poster research day 2013 Uncomplicated UTIupdated sept 27 2013_n.pdf (136.5 kB)
  • Background: The 2010 guidelines for treatment of uncomplicated cystitis list trimethoprim-sulfamethoxazole (TMP-SMX) as an appropriate choice for empiric therapy if local resistance rates of uropathogens causing uncomplicated cystitis do not exceed 20%. However, urine cultures are not routinely performed for patients with suspected uncomplicated cystitis.  It is not known if data from hospital or unit specific antibiograms provide a valid surrogate measure of resistance in this setting.

    Methods: For women between the ages of 18 and 65 seen in the emergency department (ED) with suspected uncomplicated cystitis, urine cultures and susceptibility testing were performed.  Our objective was to compare TMP-SMX resistance rates for Escherichia. coli in patients who did not have a urine culture sent to the lab as part of routine care to resistance rates obtained from the hospital antibiogram and from unit (ED) specific data from our antimicrobial susceptibility platform (Vitek2¨).

    Results: From February until April 2013, 133 patients seen in the ED with suspected uncomplicated cystitis were reviewed; 73 (55%) of whom did not have urine cultures performed as part of routine care (study patients).  E. coli was isolated in 33 of the 46 positive urine cultures.  TMP-SMX resistance was 18% in study patients but greater than 20% for the hospital antibiogram (21%) and the unit specific antibiogram (30%) [table].

    Conclusion: In this population, resistance rates based on study surveillance cultures indicated that TMP-SMX was appropriate for empiric cystitis therapy; whereas unit specific and hospital antibiogram rates suggested that alternative agents would be preferred.  Data from readily available antibiograms may not provide a valid measure of whether TMP-SMX should be used for empiric cystitis therapy.

    Table: Susceptibility comparisons for E. coli  isolates

    Study patients

    N=33

    Unit specific antibiogram

    N=60

    Hospital antibiogram

    N=4025

    Sex/age

    Female/18-65

    Female/18-65

    Any/any

    Time

    Feb - April 2013

    Feb - April 2013

    Year 2012

    Hospital site

    ED

    ED

    Any

    Syndrome

    Suspected uncomplicated cystitis

    Possible UTI (complicated and uncomplicated)

    Any infection

    Specimen source

    Urine

    Urine

    Any source

    TMP-SMX

    82

    70

    79

    Nuntra Suwantarat, MD, Medicine, University Hospitals Case Medical Center, Cleveland, OH, Myreen Tomas, MD, Infectious Disease, University Hospitals Case Medical Center, Ceveland, OH, Curtis J. Donskey, MD, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH and Michelle T. Hecker, MD, MetroHealth Medical Center, Cleveland, OH

    Disclosures:

    N. Suwantarat, None

    M. Tomas, None

    C. J. Donskey, None

    M. T. Hecker, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.