Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection
Duke University Health System (DUHS) generates annual antibiograms combining adult and pediatric data. We hypothesized significant susceptibility differences exist for pediatric isolates and that distributing these results would alter antibiotic choices. Susceptibility rates for Escherichia coli iso...
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| Veröffentlicht in: | Pediatrics (Evanston) 2012-09, Vol.130 (3), p.e615-e622 |
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| creator | Boggan, Joel C Navar-Boggan, Ann Marie Jhaveri, Ravi |
| description | Duke University Health System (DUHS) generates annual antibiograms combining adult and pediatric data. We hypothesized significant susceptibility differences exist for pediatric isolates and that distributing these results would alter antibiotic choices.
Susceptibility rates for Escherichia coli isolates from patients aged ≤12 years between July 2009 and September 2010 were compared with the 2009 DUHS antibiogram. Pediatric attending and resident physicians answered case-based vignettes about children aged 3 months and 12 years with urinary tract infections. Each vignette contained 3 identical scenarios with no antibiogram, the 2009 DUHS antibiogram, and a pediatric-specific antibiogram provided. Effective antibiotics exhibited >80% in vitro susceptibility. Frequency of antibiotic selection was analyzed by using descriptive statistics.
Three hundred seventy-five pediatric isolates were identified. Pediatric isolates were more resistant to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX) and less resistant to amoxicillin-clavulanate and ciprofloxacin (P < .0005 for all). Seventy-five resident and attending physicians completed surveys. In infant vignettes, physicians selected amoxicillin-clavulanate (P < .05) and nitrofurantoin (P < .01) more often and TMP-SMX (P < .01) less often with pediatric-specific data. Effective antibiotic choices increased from 68.6% to 82.2% (P = .06) to 92.5% (P < .01) across scenarios. In adolescent vignettes, providers reduced TMP-SMX use from 66.2% to 42.6% to 19.0% (P < .01 for both). Effective antibiotic choices increased from 32.4% to 57.4% to 79.4% (P < .01 and P = .01).
Pediatric E. coli isolates differ significantly in antimicrobial susceptibility at our institution, particularly to frequently administered oral antibiotics. Knowledge of pediatric-specific data altered empirical antibiotic choices in case vignettes. Care of pediatric patients could be improved with use of a pediatric-specific antibiogram. |
| doi_str_mv | 10.1542/peds.2012-0563 |
| format | Article |
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Susceptibility rates for Escherichia coli isolates from patients aged ≤12 years between July 2009 and September 2010 were compared with the 2009 DUHS antibiogram. Pediatric attending and resident physicians answered case-based vignettes about children aged 3 months and 12 years with urinary tract infections. Each vignette contained 3 identical scenarios with no antibiogram, the 2009 DUHS antibiogram, and a pediatric-specific antibiogram provided. Effective antibiotics exhibited >80% in vitro susceptibility. Frequency of antibiotic selection was analyzed by using descriptive statistics.
Three hundred seventy-five pediatric isolates were identified. Pediatric isolates were more resistant to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX) and less resistant to amoxicillin-clavulanate and ciprofloxacin (P < .0005 for all). Seventy-five resident and attending physicians completed surveys. In infant vignettes, physicians selected amoxicillin-clavulanate (P < .05) and nitrofurantoin (P < .01) more often and TMP-SMX (P < .01) less often with pediatric-specific data. Effective antibiotic choices increased from 68.6% to 82.2% (P = .06) to 92.5% (P < .01) across scenarios. In adolescent vignettes, providers reduced TMP-SMX use from 66.2% to 42.6% to 19.0% (P < .01 for both). Effective antibiotic choices increased from 32.4% to 57.4% to 79.4% (P < .01 and P = .01).
Pediatric E. coli isolates differ significantly in antimicrobial susceptibility at our institution, particularly to frequently administered oral antibiotics. Knowledge of pediatric-specific data altered empirical antibiotic choices in case vignettes. Care of pediatric patients could be improved with use of a pediatric-specific antibiogram.]]></description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2012-0563</identifier><identifier>PMID: 22891227</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adult ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Bacteria, Pathogenic ; Child ; Child, Preschool ; Children & youth ; Communicable diseases in children ; Control ; Disease susceptibility ; Dosage and administration ; Drug Resistance, Bacterial ; Drug therapy ; E coli ; Escherichia coli - drug effects ; Escherichia coli - isolation & purification ; Escherichia coli Infections - drug therapy ; Female ; Health aspects ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Pathogenic bacteria ; Pediatric communicable diseases ; Pediatrics ; Urinary tract diseases ; Urinary Tract Infections - drug therapy</subject><ispartof>Pediatrics (Evanston), 2012-09, Vol.130 (3), p.e615-e622</ispartof><rights>Copyright American Academy of Pediatrics Sep 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-32b07d99e705a70b28d212d92524ddb305240d7036b4535d8a439a9ca9c3e36d3</citedby><cites>FETCH-LOGICAL-c401t-32b07d99e705a70b28d212d92524ddb305240d7036b4535d8a439a9ca9c3e36d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22891227$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boggan, Joel C</creatorcontrib><creatorcontrib>Navar-Boggan, Ann Marie</creatorcontrib><creatorcontrib>Jhaveri, Ravi</creatorcontrib><title>Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description><![CDATA[Duke University Health System (DUHS) generates annual antibiograms combining adult and pediatric data. We hypothesized significant susceptibility differences exist for pediatric isolates and that distributing these results would alter antibiotic choices.
Susceptibility rates for Escherichia coli isolates from patients aged ≤12 years between July 2009 and September 2010 were compared with the 2009 DUHS antibiogram. Pediatric attending and resident physicians answered case-based vignettes about children aged 3 months and 12 years with urinary tract infections. Each vignette contained 3 identical scenarios with no antibiogram, the 2009 DUHS antibiogram, and a pediatric-specific antibiogram provided. Effective antibiotics exhibited >80% in vitro susceptibility. Frequency of antibiotic selection was analyzed by using descriptive statistics.
Three hundred seventy-five pediatric isolates were identified. Pediatric isolates were more resistant to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX) and less resistant to amoxicillin-clavulanate and ciprofloxacin (P < .0005 for all). Seventy-five resident and attending physicians completed surveys. In infant vignettes, physicians selected amoxicillin-clavulanate (P < .05) and nitrofurantoin (P < .01) more often and TMP-SMX (P < .01) less often with pediatric-specific data. Effective antibiotic choices increased from 68.6% to 82.2% (P = .06) to 92.5% (P < .01) across scenarios. In adolescent vignettes, providers reduced TMP-SMX use from 66.2% to 42.6% to 19.0% (P < .01 for both). Effective antibiotic choices increased from 32.4% to 57.4% to 79.4% (P < .01 and P = .01).
Pediatric E. coli isolates differ significantly in antimicrobial susceptibility at our institution, particularly to frequently administered oral antibiotics. Knowledge of pediatric-specific data altered empirical antibiotic choices in case vignettes. Care of pediatric patients could be improved with use of a pediatric-specific antibiogram.]]></description><subject>Adult</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacteria, Pathogenic</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children & youth</subject><subject>Communicable diseases in children</subject><subject>Control</subject><subject>Disease susceptibility</subject><subject>Dosage and administration</subject><subject>Drug Resistance, Bacterial</subject><subject>Drug therapy</subject><subject>E coli</subject><subject>Escherichia coli - drug effects</subject><subject>Escherichia coli - isolation & purification</subject><subject>Escherichia coli Infections - drug therapy</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Pathogenic bacteria</subject><subject>Pediatric communicable diseases</subject><subject>Pediatrics</subject><subject>Urinary tract diseases</subject><subject>Urinary Tract Infections - drug therapy</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1rHDEMhk1paLZJrj2WhV56ma1s2evxMSzpBwTSQ3I2HlsbHDwfHXug-ff1sNseCgLp8Ei86GHsA4cdV1J8mSjknQAuGlB7fMM2HEzbSKHVW7YBQN5IAHXJ3uf8AgBSafGOXQrRGi6E3rCnnxSiK3P0TZ7Ix2P0WzeU2Ec_j110aZuX7GkqsYspltdtcMVVImypn-J8prs4ljpmSuRLHIdrdnF0KdPNuV-xp693j4fvzf3Dtx-H2_vGS-ClQdGBDsaQBuU0dKINgotghBIyhA6hdggacN9JhSq0TqJxxtdCwn3AK_b5dHeax18L5WL7WNOm5AYal2w5oG5bRJQV_fQf-jIu81DTrVRrsNVmpZoT9ewS2Tj4cSj0u_gxJXomW8MfHuwt1h_vjZArvzvx9Vs5z3S00xx7N7_Wo3YVZFdBdhVkV0F14eM5xtL1FP7hf43gH3c4ir4</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Boggan, Joel C</creator><creator>Navar-Boggan, Ann Marie</creator><creator>Jhaveri, Ravi</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection</title><author>Boggan, Joel C ; Navar-Boggan, Ann Marie ; Jhaveri, Ravi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-32b07d99e705a70b28d212d92524ddb305240d7036b4535d8a439a9ca9c3e36d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Bacteria, Pathogenic</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children & youth</topic><topic>Communicable diseases in children</topic><topic>Control</topic><topic>Disease susceptibility</topic><topic>Dosage and administration</topic><topic>Drug Resistance, Bacterial</topic><topic>Drug therapy</topic><topic>E coli</topic><topic>Escherichia coli - drug effects</topic><topic>Escherichia coli - isolation & purification</topic><topic>Escherichia coli Infections - drug therapy</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Microbial Sensitivity Tests</topic><topic>Pathogenic bacteria</topic><topic>Pediatric communicable diseases</topic><topic>Pediatrics</topic><topic>Urinary tract diseases</topic><topic>Urinary Tract Infections - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boggan, Joel C</creatorcontrib><creatorcontrib>Navar-Boggan, Ann Marie</creatorcontrib><creatorcontrib>Jhaveri, Ravi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boggan, Joel C</au><au>Navar-Boggan, Ann Marie</au><au>Jhaveri, Ravi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>130</volume><issue>3</issue><spage>e615</spage><epage>e622</epage><pages>e615-e622</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract><![CDATA[Duke University Health System (DUHS) generates annual antibiograms combining adult and pediatric data. We hypothesized significant susceptibility differences exist for pediatric isolates and that distributing these results would alter antibiotic choices.
Susceptibility rates for Escherichia coli isolates from patients aged ≤12 years between July 2009 and September 2010 were compared with the 2009 DUHS antibiogram. Pediatric attending and resident physicians answered case-based vignettes about children aged 3 months and 12 years with urinary tract infections. Each vignette contained 3 identical scenarios with no antibiogram, the 2009 DUHS antibiogram, and a pediatric-specific antibiogram provided. Effective antibiotics exhibited >80% in vitro susceptibility. Frequency of antibiotic selection was analyzed by using descriptive statistics.
Three hundred seventy-five pediatric isolates were identified. Pediatric isolates were more resistant to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX) and less resistant to amoxicillin-clavulanate and ciprofloxacin (P < .0005 for all). Seventy-five resident and attending physicians completed surveys. In infant vignettes, physicians selected amoxicillin-clavulanate (P < .05) and nitrofurantoin (P < .01) more often and TMP-SMX (P < .01) less often with pediatric-specific data. Effective antibiotic choices increased from 68.6% to 82.2% (P = .06) to 92.5% (P < .01) across scenarios. In adolescent vignettes, providers reduced TMP-SMX use from 66.2% to 42.6% to 19.0% (P < .01 for both). Effective antibiotic choices increased from 32.4% to 57.4% to 79.4% (P < .01 and P = .01).
Pediatric E. coli isolates differ significantly in antimicrobial susceptibility at our institution, particularly to frequently administered oral antibiotics. Knowledge of pediatric-specific data altered empirical antibiotic choices in case vignettes. Care of pediatric patients could be improved with use of a pediatric-specific antibiogram.]]></abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>22891227</pmid><doi>10.1542/peds.2012-0563</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anti-Bacterial Agents - therapeutic use Antibiotics Bacteria, Pathogenic Child Child, Preschool Children & youth Communicable diseases in children Control Disease susceptibility Dosage and administration Drug Resistance, Bacterial Drug therapy E coli Escherichia coli - drug effects Escherichia coli - isolation & purification Escherichia coli Infections - drug therapy Female Health aspects Humans Infant Male Microbial Sensitivity Tests Pathogenic bacteria Pediatric communicable diseases Pediatrics Urinary tract diseases Urinary Tract Infections - drug therapy |
| title | Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection |
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