Methods: This was a single-center, retrospective chart review of adult patients discharged from the ED with a UTI from August to December 2017. Descriptive statistics were used to compare the antibiotic susceptibilities of pathogens isolated from urine cultures to the institutional and local Brooklyn antibiogram. Antibiotic susceptibilities were determined by MicroScan. Data on antibiotic prescribing patterns and previously described risk factors for multidrug resistant organisms were collected.
Results: 246 patients were included with 267 isolates identified. 61% (151) of patients were between ages 18 to 65 years old and 73% (180) were female. The most common organism isolated was Escherichia coli (164, 62%). E. coli urine isolates were most susceptible to nitrofurantoin (98%) followed by cefazolin (81%), ciprofloxacin (84%) and sulfamethoxazole/trimethoprim (64%). There was no difference in susceptibility rates of E. coli to cefazolin or sulfamethoxazole/trimethoprim but isolates were more susceptible to ciprofloxacin in the ED compared to the institutional antibiogram (84% vs. 70%). 26 (10.6%) patients grew an ESBL organism and of these, 42% (11/26) had no identifiable healthcare exposure within the last 90 days.
Conclusion: Despite limitations in sample size, this study supports using separate antibiograms and pathways for the treatment of UTI in the ED, especially in a community with high rates of local resistance to first-line agents.
S. Simon, None
N. Rothberger, None
S. Mayer, None