The superbugs are coming!

Abstract

Because the media has stolen all the catchy names—MRSA, VRSA, VRE, C Diff et al—I’d like to be the first to coin the term “PREC” (penicillin-resistant E. coli). * ### The study. This was a retrospective examination of pediatric urine culture isolates from clinical laboratories collected in a variety of inpatient and outpatient settings across the United States in 2009. The aim was to compare antibiotic resistance patterns among common uropathogens obtained for outpatients and inpatients. ### The key findings. The authors identified 5560 inpatient and 25 418 outpatient urinary isolates. Here’s their table on prevalence of common species: View this table: You’ll have to check the article to see all the resistance patterns that were measured, but suffice it to say that inpatient resistance rates frequently exceeded outpatient resistance rates, particularly for third-generation cephalosporins and ciprofloxacin. Most notably (in my opinion anyway) was Escherichia coli resistance to ampicillin in the outpatient and inpatient settings (45% vs 55%, P < .001). #### Why do we care? This article substantiates the claim previously suggested by single-center studies that resistance patterns for uropathogens differ in the outpatient and inpatient settings. Thus, we should likely be using separate inpatient- and outpatient-based antibiograms to optimize effective empirical antibiotic use for treatment of urinary tract infection. That said, it is probably worth pointing out that there is site-to-site variability in determining who gets admitted for urinary tract infections (UTI), and this study was not designed to address this confounder or, more specifically, to account for severity of illness. #### Words from a hospitalist . . . “The common, often reflexive, empiric inpatient UTI management is getting a little trickier thanks …