Project Title

Inpatient versus Outpatient Pediatric Antibiograms: An Analysis Looking for Significant Difference

Authors' Affiliations

Mark Aujla, College of Medicine, East Tennessee State University, Johnson City, TN Demetrio Macariola Jr, Department of Pediatrics, College of Medicine, East Tennessee State University, Johnson City, TN

Faculty Sponsor’s Department

Pediatrics

Name of Project's Faculty Sponsor

Dr. Demetrio Macariola

Type

Poster: Competitive

Classification of First Author

Medical Student

Project's Category

Child Health

Abstract Text

Antibiograms are aggregates of susceptibility testing data of pathogens over a period of time. Bacteria are cultured from infected patients. Once identified, a pathogen undergoes testing against common antibiotics, indicating the effectiveness of specific antibiotics to the pathogen identified. This data gives clinicians an understanding of which antibiotics face increasing resistance in their communities. This project involved the development of a pediatric outpatient antibiogram which was compared against a regional inpatient pediatric antibiogram. The goal was to identify a significant difference in susceptibility between inpatient and outpatient pediatric infections.

All urine cultures ordered within the ETSU Health pediatrics department over the course of 1 year between September 2018 and September 2019 were examined. There were 251 such cultures, of these 52 were abnormal, and required antibiotic treatment. All abnormal urine cultures were examined for pathogen identity, and susceptibility data. Pathogens were stratified by species and their susceptibility to commonly utilized antibiotics was aggregated and expressed as a percentage. This analysis did not distinguish between intermediate and resistant strains of bacteria, both results were marked resistant. There were 3 patients that presented with repeat cultures. Two of these patients presented with a single species of bacteria on follow-up cultures, and subsequent samples were excluded. One patient presented with two different urine cultures at different points in the year, and both samples were included.

When stratified based on species, only E. Coli, with 30 unique samples, presented enough statistical power for analysis. We compared community and hospital pediatric antibiograms and found no statistical difference in susceptibility in E. Coli. However, analysis showed significant difference between both pediatric antibiograms and the inpatient adult antibiogram. We found significant difference in susceptibility between samples for ampicillin 11%, ampicillin-sulbactam 34%, tetracycline 21%, levofloxacin 21%, and Trimethoprim-sulfamethoxazole 12%. The adult antibiogram demonstrated lower susceptibility against all of these antibiotics. Additional research is necessary in this area. Based on this analysis, we cannot recommend pediatric community antibiogram creation. However, the differences observed between adult and pediatric antibiograms indicate a utility for continued stratification of antibiograms by age.

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Inpatient versus Outpatient Pediatric Antibiograms: An Analysis Looking for Significant Difference

Antibiograms are aggregates of susceptibility testing data of pathogens over a period of time. Bacteria are cultured from infected patients. Once identified, a pathogen undergoes testing against common antibiotics, indicating the effectiveness of specific antibiotics to the pathogen identified. This data gives clinicians an understanding of which antibiotics face increasing resistance in their communities. This project involved the development of a pediatric outpatient antibiogram which was compared against a regional inpatient pediatric antibiogram. The goal was to identify a significant difference in susceptibility between inpatient and outpatient pediatric infections.

All urine cultures ordered within the ETSU Health pediatrics department over the course of 1 year between September 2018 and September 2019 were examined. There were 251 such cultures, of these 52 were abnormal, and required antibiotic treatment. All abnormal urine cultures were examined for pathogen identity, and susceptibility data. Pathogens were stratified by species and their susceptibility to commonly utilized antibiotics was aggregated and expressed as a percentage. This analysis did not distinguish between intermediate and resistant strains of bacteria, both results were marked resistant. There were 3 patients that presented with repeat cultures. Two of these patients presented with a single species of bacteria on follow-up cultures, and subsequent samples were excluded. One patient presented with two different urine cultures at different points in the year, and both samples were included.

When stratified based on species, only E. Coli, with 30 unique samples, presented enough statistical power for analysis. We compared community and hospital pediatric antibiograms and found no statistical difference in susceptibility in E. Coli. However, analysis showed significant difference between both pediatric antibiograms and the inpatient adult antibiogram. We found significant difference in susceptibility between samples for ampicillin 11%, ampicillin-sulbactam 34%, tetracycline 21%, levofloxacin 21%, and Trimethoprim-sulfamethoxazole 12%. The adult antibiogram demonstrated lower susceptibility against all of these antibiotics. Additional research is necessary in this area. Based on this analysis, we cannot recommend pediatric community antibiogram creation. However, the differences observed between adult and pediatric antibiograms indicate a utility for continued stratification of antibiograms by age.