You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013643 A COMPARISON OF INPATIENT VERSUS OUTPATIENT RESISTANCE PATTERNS IN PEDIATRIC URINARY TRACT INFECTION Kara N. Saperston, Dan J. Shapiro, Adam L. Hersh, and Hillary L. Copp Kara N. SaperstonKara N. Saperston San Francisco, CA More articles by this author , Dan J. ShapiroDan J. Shapiro San Francisco, CO More articles by this author , Adam L. HershAdam L. Hersh Salt Lake City, UT More articles by this author , and Hillary L. CoppHillary L. Copp San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.196AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Most antibiograms for uropathogens are derived from hospital-based laboratory data. There is evidence that these data may provide inaccurate information about ambulatory uropathogen resistance patterns. The goal of the present study was to compare current national patterns of inpatient and outpatient antibiotic resistance in pediatric UTI. METHODS We examined inpatient and outpatient urinary isolates from children <18 years using The Surveillance Network® (TSN®), a database with antibiotic susceptibility results and patient demographic data from 195 US hospitals. We determined the prevalence and antibiotic resistance patterns for the six most common uropathogens: Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa, and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for inpatient and outpatient isolates with chi-square analysis. RESULTS We identified 25,418 outpatient (86% female) and 5560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall, but the prevalence of Escherichia coli varied by sex and visit setting: outpatient isolates (79% of uropathogens overall: females 83%, males 50%) versus inpatient isolates (54% overall: females 64%, males 37%) (p<0.001). Resistance rates for many commonly prescribed antibiotics were higher in the inpatient versus outpatient setting: Escherichia coli: TMP/SMX (30% vs. 24%) and cephalothin (22% vs. 16%) (p<0.001); Klebsiella: cephalothin (14% vs. 7%) (p=0.03); Enterobacter: ceftriaxone (24% vs. 12%) and ceftazidime (33% vs. 15%) (p<0.001); Enterococcus: ampicillin (13% vs. 3%) and ciprofloxacin (12% vs. 5%) (p<0.001). Resistance rates between Proteus and Pseudomonas were similar between inpatient and outpatient isolates. CONCLUSIONS Uropathogen resistance rates for several of the most common antibiotic agents are substantially higher for urinary specimens obtained from inpatients than from outpatients. Separate hospital- and community-based antibiograms should be performed to optimize empiric-prescribing choices for UTI in children. Prevalence of uropathogen by sex and visit setting Organism Male Outpt Prevalence Male Inpt Prevalence P-value Female Outpt Prevalence Female InPt Prevalence P-value E. Coli 50% (48–52) 37% (35–39) <0.001 83% (83–84) 64% (63–66) <0.001 Enterobacter 5% (5–6) 10% (8–11) <0.001 1% (1–1) 4% (4–5) <0.001 Enterococcus 17% (16–18) 27% (25–29) <0.001 5% (5–5) 13% (12–14) <0.001 Klebsiella 10% (9–11) 12% (10–13) 0.07 4% (4–5) 10% (9–11) <0.001 P. aeruginosa 7% (6–8) 10% (8–11) <0.001 2% (2–2) 6% (5–7) <0.001 P. mirabilis 11% (10–12) 5% (4–6) <0.001 4% (4–4) 2% (2–3) <0.001 No. of observ. 3,437 2,072 21,981 3,488 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e263 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kara N. Saperston San Francisco, CA More articles by this author Dan J. Shapiro San Francisco, CO More articles by this author Adam L. Hersh Salt Lake City, UT More articles by this author Hillary L. Copp San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...