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Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection

Joel C Boggan1, Ann Marie Navar-Boggan, Ravi Jhaveri

  • 1Department of Medicine, Duke University Medical Center, DUMC 3499, Durham, NC 27710, USA.

Pediatrics
|August 15, 2012
PubMed

Insights

Pediatric E. coli isolates show different antibiotic susceptibility compared to adults. Using a pediatric-specific antibiogram improved antibiotic choices for children with urinary tract infections.

Area of Science:

  • Medical Microbiology
  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship

Background:

  • Duke University Health System (DUHS) currently combines adult and pediatric data for annual antibiograms.
  • This practice may obscure significant differences in antimicrobial susceptibility specific to pediatric populations.
  • Hypothesized that pediatric-specific susceptibility data would influence antibiotic prescribing patterns.

Purpose of the Study:

  • To determine if significant differences in antimicrobial susceptibility exist for pediatric *Escherichia coli* isolates.
  • To evaluate the impact of distributing pediatric-specific antibiogram data on physician antibiotic choices for pediatric urinary tract infections (UTIs).

Main Methods:

  • Compared susceptibility rates of *E. coli* isolates from pediatric patients (≤12 years) to the 2009 DUHS antibiogram.
  • Physicians responded to case vignettes involving pediatric UTIs under three conditions: no antibiogram, 2009 DUHS antibiogram, and pediatric-specific antibiogram.
  • Analyzed frequency of antibiotic selection based on >80% in vitro susceptibility and descriptive statistics.

Main Results:

  • Pediatric isolates exhibited higher resistance to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX) and lower resistance to amoxicillin-clavulanate and ciprofloxacin compared to the general antibiogram (P < .0005).
  • Use of pediatric-specific data led to increased selection of amoxicillin-clavulanate and nitrofurantoin and decreased selection of TMP-SMX in infant vignettes.
  • Effective antibiotic choices for infants increased from 68.6% to 92.5% (P < .01), and for adolescents from 32.4% to 79.4% (P < .01).

Conclusions:

  • Significant differences in antimicrobial susceptibility for pediatric *E. coli* isolates necessitate distinct data.
  • Availability of pediatric-specific antibiogram data demonstrably altered empirical antibiotic selection in simulated clinical scenarios.
  • Implementing a pediatric-specific antibiogram can enhance the appropriate treatment of UTIs in children.
Abstract

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