1865. Antibiotic Susceptibilities of Organisms Isolated from Urine Cultures of Patients Diagnosed with a Urinary Tract Infection (UTI) and Discharged from the Emergency Department (ED)

Abstract

BackgroundUrinary tract infections (UTIs) are among the most commonly treated infections in the Emergency Department (ED). Treatment is largely empiric and based on an institution-wide antibiogram comprised of isolates from all infection sites, which may overestimate antibiotic resistance of urinary pathogens of nonadmitted ED patients. The primary goal of this study was to determine the antibiotic susceptibilities of urinary pathogens isolated from adult patients with a UTI and discharged from the ED.MethodsThis 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.ResultsTwo hundred forty-six 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 with the institutional antibiogram (84% vs. 70%). Twenty-six (10.6%) patients grew an ESBL organism and of these, 42% (11/26) had no identifiable healthcare exposure within the last 90 days.ConclusionDespite 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.Disclosures All authors: No reported disclosures.