The IDSA recommends the use of sulfamethoxazole-trimethoprim (SXT) as empiric therapy (E/T) for uncomplicated urinary tract infections (UTI) in areas where the resistance rate is <20%. We sought to describe the susceptibility patterns of urinary E. coli isolates from an urban pediatric outpatient centers/schools and analyze antibiotic (ABX) prescribing to encourage use of cephalexin (LEX) as E/T for uncomplicated UTI.
This is a retrospective analysis of outpatient UTI management from 12/2016 to 4/2017. Patients (pts) were identified using ICD-10 codes related to UTI or associated symptoms, and chart review was performed by electronic medical record (EMR). Demographic, clinical and laboratory data were collected. The primary endpoint was the choice of ABX for E/T for UTI. Fishers Exact, and χ2 tests were used for data analysis.
We identified 1138 pts with appropriate ICD-10 codes and a retrievable EMR. Of those 1138, 882 (78%) received no ABXs, 14 (1%) received an ABX for other indications, and 242 (21%) were prescribed an ABX for UTI E/T. There were 834 (73.3%) female pts and the median age was 11 years (yrs) (range: 1 week to 21 yrs). The top 4 ABXs prescribed for E/T were SXT 83/242 (34.3%), nitrofurantoin 44/242 (18.2%), LEX 27/242 (11.2%), and ciprofloxacin 21/242 (8.7%). LEX was prescribed 64.3% in the youngest and 8.8% in the oldest age groups for E/T UTIs, p<0.001 (Table 1). The rate of return to the clinic or emergency room with recurrent UTI symptoms for patients prescribed SXT at 6 months was 13.6% compared to LEX was 0%, p=0.03. The 3-month clinic or emergency room rate for recurrent UTI symptoms with nitrofurantoin E/T was 25% versus SXT 8.4%, p=0.01 (Table 2). There were 108 E. coli isolates and susceptibility percentages were calculated. E. coli susceptibility to LEX in children aged 0-3, 4-12, 13-21 yrs was 100%, 77.8%, 95.5%, respectively, p=0.02 (Table 3).
Outpatient providers chose SXT as E/T for 34.3% of UTI though E. coli was susceptible at a rate of only 74.1%. Additionally, there was a trend toward fewer returns within 3 and 6 months of the initial visit when LEX was used as treatment. LEX should be considered for UTI E/T for ages 13-21 yrs, where SXT is currently the most common E/T.
V. Soma, None