TWO SIMPLE RULES FOR IMPROVING ACCURACY OF EMPIRIC TREATMENT FOR MULTIDRUG RESISTANT URINARY TRACT INFECTIONS.
Antimicrob Agents Chemother. 2015 Sep 28;
Authors: Linsenmeyer K, Strymish J, Gupta K
BACKGROUND: Emergence of multi-drug resistant uropathogens (MDR UTI) is making treatment of UTI more challenging. We sought to evaluate the accuracy of empiric therapy for MDR UTI and the utility of prior culture data in improving accuracy.
METHODS: Retrospective review of electronic health record for treatment of MDR UTI from 3 VA facilities over 3 years. MDR UTI was defined as an uropathogen resistant to 3 or more classes of drugs and clinician identified infection requiring therapy. Previous culture data, antimicrobial use, and outcomes were captured from inpatient and outpatient settings.
RESULTS: Among 126 patient episodes of MDR UTI, empiric therapy choices were accurate against the index pathogen in 66 (52%) of episodes. For the 95 patient episodes with prior microbiology available, when empiric therapy was concordant with prior microbiologic data, accuracy against the uropathogen improved from 32% to 76% (OR 6.9 CI: 2.7-17.1; p<0.001). Genitourinary-directed (nitrofurantoin or sulfa) agents were equally as likely as broad-spectrum agents to be accurate (p=0.3).
CONCLUSIONS AND RELEVANCE: Choosing an agent concordant with previous microbiologic data significantly increased the chance of accuracy for MDR UTI, even if the previous uropathogen was a different species. Also, GU-directed or broad therapy choices were equally likely to be accurate. Accuracy of empiric therapy could be improved using these simple rules.
PMID: 26416859 [PubMed - as supplied by publisher]