title: Comparison of hospital-wide and age and location - stratified antibiograms of S. aureus, E. coli, and S. pneumoniae: age- and location-stratified antibiograms.
abstract: BACKGROUND
  Antibiograms created by aggregating hospital-wide susceptibility data from diverse patients can be misleading. To demonstrate the utility of age- and location-stratified antibiograms, we compared stratified antibiograms for three common bacterial pathogens, E. coli, S. aureus, and S. pneumoniae. We created stratified antibiograms based on patient age (<18 years, 18-64 years, >/=65 years), and inpatient or outpatient location using all 2009 E. coli and S. aureus, and all 2008-2009 S. pneumoniae isolates submitted to our clinical microbiology laboratory. We compared susceptibility rates among cumulative and stratified antibiograms using descriptive statistics.
  
  
  RESULTS
  For E. coli and S. aureus, the institution-wide antibiogram overestimated resistance in pediatic isolates and underestimated resistance in isolates from the elderly. For E. coli, pediatric isolates were less susceptible to ampicillin and ampicillin-sulbactam and more susceptible to gentamicin and ciprofloxacin compared to adult isolates (p < 0.05 for all), and isolates from patients >65 years were least susceptible to ciprofloxacin (71%). For S. aureus, susceptibility to oxacillin, clindamycin, and levofloxacin was highest among children and decreased with increasing age (p < .001 for all). For S. pneumoniae, pediatric isolates were less susceptible than adult isolates to all agents except penicillin (IV breakpoint). Within children there were significant differences in susceptibility of inpatient and outpatient isolates of E. coli but not of S. aureus or S. pneumoniae.
  
  
  CONCLUSIONS
  Stratified antibiograms reveal age - associated differences in susceptibility of E. coli, S. aureus, and S. pneumoniae that are obscured by hospital-wide antibiograms. Age-stratified antibiograms have potential to influence antibiotic selection.
authors.affiliation: Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA.
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Swami
authors.forename: Ritu
authors.initials: R
authors.lastname: Banerjee
keywords: Age-stratified; Antibiogram; E. coli; S. aureus; S. pneumoniae