title: Comparison of antibiotic susceptibility of Escherichia coli in urinary isolates from an emergency department with other institutional susceptibility data.
abstract: OBJECTIVE
  The antibiotic susceptibility of Escherichia coli in isolates from patients with uncomplicated urinary tract infection (UTI) in an emergency department (ED) was compared with susceptibility data from the associated hospital.
  
  
  METHODS
  Patients eligible for study participation included women age 18-65 years with one or more symptoms consistent with a UTI for whom a urine dipstick, urinalysis, or urine culture was ordered. Clinical decision-making, including the decision to order a urine culture, was at the discretion of the individual healthcare provider; however, a deidentified urine culture and antimicrobial susceptibility testing were performed for those study participants for whom a urine culture was not ordered. We compared the E. coli-specific antibiogram for uncomplicated UTI to the antibiogram based on all urine cultures in the ED regardless of patient disposition, non-intensive care unit (ICU) hospital inpatients, and the hospitalwide antibiogram.
  
  
  RESULTS
  Of the 578 ED patients screened for study eligibility, 119 met the inclusion criteria. E. coli, detected in 53 (74%) of the 72 pathogen-positive cultures, was the most common pathogen isolated. For E. coli, ciprofloxacin nonsusceptibility was significantly less common in isolates from ED patients with uncomplicated cystitis and pyelonephritis than in isolates from non-ICU inpatients or from the hospitalwide population. E. coli nonsusceptibility to ciprofloxacin was significantly less common in ED isolates from patients with uncomplicated UTI than in isolates from all ED patients with clinician-ordered urine cultures.
  
  
  CONCLUSIONS
  Antibiotic susceptibility of E. coli in an ED and its associated hospital depended on factors such as whether patients were hospitalized and whether ED isolates were from patients with uncomplicated UTI.
authors.affiliation: Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University.
authors.forename: Catherine
authors.initials: C
authors.lastname: Zatorski
authors.affiliation: Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University.
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Jordan
authors.affiliation: Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.affiliation: Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University.
authors.forename: Mark
authors.initials: M
authors.lastname: Zocchi
authors.affiliation: Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University. larissa.may@gmail.com.
authors.forename: Larissa
authors.initials: L
authors.lastname: May
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004198:Disease Susceptibility / Q000175:diagnosis / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends*; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents