1579. Developing an Inpatient Urinary Antibiogram at Rochester General Hospital (RGH): A Look Into the Impact of Patient Factors on E. coli Susceptibilities
Session: Poster Abstract Session: Clinical Infectious Diseases: UTIs
Saturday, October 10, 2015
Room: Poster Hall
Background: It is important to choose appropriate empiric therapy for UTIs to prevent treatment failure. However, identification and susceptibility of urine isolates take time; therefore inpatient treatment is usually guided by known antibiotic susceptibilities that are published yearly on what is known as an antibiogram. However, standard antibiograms (SA) have several clinical limitations as they are not disease specific, and do not take into consideration patient factors. The goal of this study was to develop a urinary antibiogram (UA), as well as identify risk factors that affect urine E. coli susceptibilities with the goal of guiding providers to make a more clinical decision when choosing empiric antibiotics for UTIs.  

Methods: Single center retrospective study between May-October 2014. First, our UA was developed by reviewing antibiotic susceptibilities of all inpatient urine isolates. It was then compared to the RGH SA. Secondly, chart review of inpatient admissions to the corresponding E. coli isolates were done to identify more than 20 patient factors.

Results: 856 isolates were included in the UA. In comparison to the SA, urine isolates had a higher ESBL prevalence  (7% UA vs. 4% SA, p=0.02) and tended to be more resistant to antibiotics, most notably Ciprofloxacin (Cipro) (74% vs 79% susceptible, p= 0.03). Of the 480 urine E. coli isolates (49%), there were several patient factors that impacted Cipro susceptibility. Prior history of ESBL (7% vs. 76%, p= <0.001, OR 9.9 CI 1.0-94.0), MDRO (29% vs. 79%, p=<0.001, OR 4.9, CI 2.0-12.0) or VRE (32% vs. 76%, p= 0.002, OR 6.9 CI 2.0-24.0), antibiotics in past 90 days (59% vs. 81%, p=0.007, OR 2.9 CI 1.3-6.5), nursing home residence (39% vs. 77% p= <0.001, OR 4.9 CI 2.3-10.0), history of kidney stone (62% vs. 75%, p=0.007, OR 3.0, CI 1.3-6.6), and immunocompromised status (60% vs. 75%, p=0.02, OR 2.9 CI 1.2-7.4) were factors found to be statistically significant in multivariate analysis.

Conclusion: At RGH in comparison to the SA, the UA revealed increased resistance to several antibiotic drug classes, with Cipro susceptiblity being impacted significantly by several patient factors. Therefore, when selecting empiric antibiotics for the treatment of UTIs, caution should be used when choosing Cipro and risk factors should be considered.

Rachel Karmally, MD, Internal Medicine, Rochester General Hospital, Rochester, NY, Maryrose Laguio, MD, Infectious Disease, Rochester General Hospital, Rochester, NY, Mindee Hite, PharmD, ICU, Rochester General Hospital, Rochester, NY and Junaid Hashim, BA, Rochester General Hospital, Rochester, NY

Disclosures:

R. Karmally, None

M. Laguio, None

M. Hite, None

J. Hashim, None

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