Institutional antibiograms can help guide empiric antibiotic therapy but may miss differences in resistance across patient sub-populations or clinical syndromes. The usefulness of antibiograms that estimate the risk of organism-drug mismatch for community-acquired skin and soft tissue infections (SSTIs) and urinary tract infections (UTIs) in pediatrics is poorly understood.
We constructed a complete line-listing of Staphylococcus aureus isolates from skin and soft tissue body sites (October 1st, 2015 to May 1st, 2017) and Gram negative bacilli from urine isolates (October 2nd, 2016 to May 1st, 2017) from patients ≤18 years hospitalized at Lurie Children’s Hospital. A cohort of previously healthy patients, defined as those without comorbidities (using ICD-10 diagnostic coding for complex medical conditions), prior admissions (within 1 year), or recent antibiotic use (within 90 days), was constructed using administrative and pharmacy data from the electronic health record (EHR). Syndrome-specific antibiograms were generated for commonly used empiric agents.
A total of 767 SSTI and 812 UTI isolates were identified. Compared to UTI isolates from all patients, antibiotic susceptibility rates were significantly higher among previously healthy patients for amoxicillin/clavulanic acid (77.0% vs 85.7%, p=0.0003), cefazolin (58.3% vs 65.4%, p=0.018), and ceftriaxone (86.2% vs 92.1%, p=0.0025), but not for trimethoprim/sulfamethoxazole (70.5% vs. 76.5%, p=0.15). A comparison of SSTI isolates did not reveal differences in susceptibility for clindamycin (77.6% vs 81.7%, p=0.17), oxacillin (71.3% vs 73.7%, p=0.48), and trimethoprim/sulfamethoxazole (89.7% vs 92.6%, p=0.24).
We demonstrated the feasibility of constructing EHR-derived syndrome-specific antibiograms for a cohort of children without chronic medical conditions. Our methodology can be applied to create antibiograms tailored to a variety of clinical presentations. For UTIs, automated antibiograms for previously healthy children can avoid overestimation of resistance and better guide empiric therapy.
S. Patel, None