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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
Summary
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.
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