title: A comparison of inpatient versus outpatient resistance patterns of pediatric urinary tract infection.
abstract: OBJECTIVE
  Prior single center studies showed that antibiotic resistance patterns differ between outpatients and inpatients. We compared antibiotic resistance patterns for urinary tract infection between outpatients and inpatients on a national level.
  
  
  METHODS
  We examined outpatient and inpatient urinary isolates from children younger than 18 years using The Surveillance Network (Eurofins Scientific, Luxembourg, Luxembourg), a database of antibiotic susceptibility results, as well as patient demographic data from 195 American hospitals. We determined the prevalence and antibiotic resistance patterns of the 6 most common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for outpatient and inpatient isolates using chi-square analysis.
  
  
  RESULTS
  We identified 25,418 outpatient (86% female) and 5,560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall but its prevalence varied by gender and visit setting, that is 79% of uropathogens overall for outpatient isolates, including 83% of females and 50% of males, compared to 54% for overall inpatient isolates, including 64% of females and 37% of males (p <0.001). Uropathogen resistance to many antibiotics was lower in the outpatient vs inpatient setting, including trimethoprim/sulfamethoxazole 24% vs 30% and cephalothin 16% vs 22% for E. coli (each p <0.001), cephalothin 7% vs 14% for Klebsiella (p = 0.03), ceftriaxone 12% vs 24% and ceftazidime 15% vs 33% for Enterobacter (each p <0.001), and ampicillin 3% vs 13% and ciprofloxacin 5% vs 12% for Enterococcus (each p <0.001).
  
  
  CONCLUSIONS
  Uropathogen resistance rates of several antibiotics are higher for urinary specimens obtained from inpatients vs outpatients. Separate outpatient vs inpatient based antibiograms can aid in empirical prescribing for pediatric urinary tract infections.
authors.affiliation: University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah.
authors.forename: Kara N
authors.initials: KN
authors.lastname: Saperston
authors.affiliation: University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Shapiro
authors.affiliation: University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah.
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Copp
mesh_terms: D000553:Ambulatory Care; D003428:Cross Infection / Q000188:drug therapy; D004352:Drug Resistance, Microbial; D004754:Enterobacter; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology; D004927:Escherichia coli Infections; D005260:Female; D006760:Hospitalization; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology; D056689:Uropathogenic Escherichia coli / Q000187:drug effects
keywords: anti-bacterial agents; drug resistance; inpatients; outpatients; urinary tract infections