Jorgensen S, Zurayk M, Yeung S, Terry J, Dunn M, Nieberg P, Wong-Beringer A
Department of Pharmacy, Huntington Hospital, Pasadena, California, USA.
University of Southern California, School of Pharmacy, Los Angeles, California, USA.
J Clin Microbiol. 2017 Sep;55(9):2629-2636. doi: 10.1128/JCM.00481-17. Epub 2017 Jun 14.
Patients presenting to the emergency department (ED) represent a heterogeneous population comprised of all ages, various backgrounds, such as from the community and skilled-nursing facilities (SNFs), and at various risks for resistant pathogens. The aim of this study was to compare patient group-specific urinary antibiograms in the ED. Adults presented to the ED with an ICD 9/10 code urinary tract infection (UTI) diagnosis during July 2015 to June 2016 were randomly selected ( = 500) to extract relevant demographic, laboratory, and clinical data from the medical record. Urinary antibiograms were compared between institutional versus ED and among ED patients (male versus female; age of 18 to 64 years versus ≥65 years; female aged 18 to 50 years versus >50 years; home versus SNF; and admitted versus discharged). grew from 56% (145/259) of the positive urine cultures. Overall ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (SXT), and cefazolin (CFZ) susceptibilities were <71%. Differences in antibiograms were the following: lower CFZ and SXT susceptibilities in ED versus institutional (CFZ, 67% versus 86% [ = 0.001]; SXT, 66% versus 74% [ = 0.02]), lower ampicillin and gentamicin susceptibilities in females aged 18 to 50 years versus >50 years (32% versus 52% [ = 0.04]; 78% versus 93% [ = 0.02]), lower CIP susceptibilities in the elderly (64% versus 81%; = 0.03), SNF versus home (35% versus 77%; < 0.001), admitted versus discharged (63% versus 78%; = 0.04), and lower SXT susceptibilities in patients aged <65 years versus the elderly (58% versus 71%; = 0.01). Nitrofurantoin showed >80% susceptibility in all groups. Patient group-specific urinary antibiograms revealed distinct differences in susceptibility and should be developed to better inform empirical UTI therapy selection in the ED.
到急诊科就诊的患者构成了一个异质性群体，涵盖了所有年龄段、各种背景，如来自社区和专业护理机构（SNFs），且对耐药病原体存在不同风险。本研究的目的是比较急诊科特定患者群体的尿液抗菌谱。随机选取2015年7月至2016年6月期间因国际疾病分类第9/10版代码诊断为尿路感染（UTI）而到急诊科就诊的成年人（n = 500），从病历中提取相关的人口统计学、实验室和临床数据。比较了机构患者与急诊科患者之间以及急诊科患者内部（男性与女性；18至64岁与≥65岁；18至50岁女性与>50岁女性；居家患者与专业护理机构患者；入院患者与出院患者）的尿液抗菌谱。[某种细菌]在56%（145/259）的阳性尿培养物中生长。总体而言，环丙沙星（CIP）、甲氧苄啶 - 磺胺甲恶唑（SXT）和头孢唑林（CFZ）的敏感性均<71%。抗菌谱的差异如下：急诊科患者中CFZ和SXT的敏感性低于机构患者（CFZ，67%对86%[P = 0.001]；SXT，66%对74%[P = 0.02]），18至50岁女性中氨苄西林和庆大霉素的敏感性低于>50岁女性（32%对52%[P = 0.04]；78%对93%[P = 0.02]），老年人中CIP的敏感性低于其他年龄段（64%对81%；P = 0.03），专业护理机构患者低于居家患者（35%对77%；P < 0.001），入院患者低于出院患者（63%对78%；P = 0.04），<65岁患者中SXT的敏感性低于老年人（58%对71%；P = 0.01）。呋喃妥因在所有组中的敏感性均>80%。特定患者群体的尿液抗菌谱显示出[某种细菌]敏感性的明显差异，应进一步完善以更好地指导急诊科尿路感染经验性治疗的选择。
