Methods: Retrospective cohort study of adult patients from emergency department with positive urine cultures at a tertiary care medical center in Bangor, Maine. Study began by developing a community specific urine antibiogram from 2013 to 2016. Then, patients were divided into two groups depending on empiric antibiotic given at discharged according to the susceptibility of antibiotic defined from the community specific urine antibiogram: high susceptibility defined as greater than or equal to 90% or moderate to low defined as less than 90%. Primary outcome was to evaluate 30-day readmission between the susceptibility groups.
Results: A total of 594 patients were included for analysis. E. coli, Klebsiella spp. and Proteus spp. were the most common urine pathogens (75.5%, 9.1% and 3.2%). A total of 55.1% patients were given a high susceptibility antibiotic (n=327) and the remaining patients (n=267) were in the moderate to low susceptibility group. Readmission to the ED or hospital within 30 days with signs and symptoms of UTI was higher in moderate to low susceptibility (14.2%) compared to that of high susceptibility (7.95%); p=0.0140. After adjusting for confounders, moderate to low susceptibility adjusted odds ratio was 1.74; 95% CI (1.01, 2.99); p=0.047.
Conclusion: A patient empirically treated with a moderate to low susceptibility antibiotic such as trimethoprim/sulfamethoxazole, the odds of being readmitted within 30 days are 1.74 times greater than the odds of empiric treatment with a high susceptibility antibiotic (e.g. cephalexin). Creating a community source specific urinary pathogen antibiogram to base the empiric antibacterial therapy for ED patients with urinary tract infection may be a useful tool in reduction of 30 day readmission rates.
A. M. Casapao, None