Evaluation of Susceptibility Patterns in Uropathogens and Empiric Antibiotic Therapy in the Emergency Department

Objectives: Urinary Tract Infections (UTIs) are the most common bacterial infections encountered in the Emergency Department (ED). Objectives of this study are to describe the urological pathogens associated with UTIs in the ED, report antibiotic susceptibilities, and assess empiric antibiotic treatment. Methods: A retrospective chart review of 154 patients with positive urine cultures from January to June 2016 were reviewed for inclusion in the study. Patients were excluded if less than 18 years of age, hospitalized, discharged from the ED without antibiotics or diagnosed with pyelonephritis. Patient demographics, uropathogens isolated, in-vitro susceptibility to commonly prescribed oral antibiotics (nitrofurantoin, ciprofloxacin, and sulfamethoxazole/trimethoprim), and antibiotics selected for treatment were recorded. Results: One hundred patients were included in the final analysis. Of the 106 bacterial isolates, Escherichia coli, Klebsiella pneumoniae, and Group B Streptococcus accounted for 62.5%, 8%, and 8% of pathogens, respectively. Overall susceptibilities were 88.1%, 87.9%, 85.4%, and 70.6% for nitrofurantoin, cefazolin, ciprofloxacin, and sulfamethoxazole/trimethoprim, respectively. Escherichia coli was most susceptible to nitrofurantoin at 96.9% followed by cefazolin at 94%. Ciprofloxacin was the most prescribed antibiotic followed by cephalexin, nitrofurantoin and sulfamethoxazole/trimethoprim. Conclusions: Based on bacterial susceptibility patterns, nitrofurantoin and cephalexin are reasonable first line agents in the empiric treatment of urinary tract infections identified in the emergency department. The most frequently prescribed antibiotic was ciprofloxacin, highlighting the importance of implementing antimicrobial stewardship initiatives and designing specific tools and educational programs for the emergency department targeted at minimizing fluoroquinolone use.