UTI recommendation antibiogram discrepancy

Question

I’m a 1st year family practice resident and was wondering why there is some apparent discrepancy between your tx recommendations and the VIHA 2013 antibiogram for UTI. Specifically, why do you recommend TMP/SMX (to which the antibiogram reports only 83% E coli sensitivity and reports Enterococcus resistance) but not ciprofloxacin (90% E coli sensitivity; 82% Enterococcus sensitivity)? Do you happen to know why the antibiogram does not include cefixime, which you includes as a 1st line agent?

I appreciate your help. Thanks.

Answer

We are actively working on better access to susceptibility information that would provide more detail. For instance, in partial answer to your question about not recommending ciprofloxacin despite overall better susceptibility than TMP/SMX, there is a very large difference in susceptibility by age. Have a look at a recent presentation I made at Wednesday Infection Rounds http://infectionnet.org/wp-content/uploads/2014/03/201403BigData.pptx.pdf . There is a graph from BCCDC that utilizes BC Bio susceptibility information by age. The presentation also talks generally about the overall efforts I referred to, to “re-purpose” transactional data (including microbiology lab information) to arrive at more informed recommendations. I envision a time that even “personalized” recommendations based on prior susceptibility testing would be possible.

Your observation on cefixime not being present in the Enterococcus spp. antibiograms is a function of cephalosporins not being active as a class against enterococci. The same holds true for TMP/SMX, hence the black boxes on the antibiogram. I completely recognize that this is very poorly communicated thus far (the best means to communicate antibiogram information is a much bigger discussion). In terms of enterococci being important to “cover for” in the empiric therapy of cystitis, most authorities do not think that they are.

In the near future I will be focusing on diagnosis and therapy of UTI in infectionNet. Your questions help!

Answered by Jim Hutchinson.

Category: Urinary Tract Infections

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