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Objective: To calculate the emergency department (ED)-level Escherichia coli percentage of isolates susceptible to commonly used antibiotics and to determine the risk factors associated with inadequate empiric antibiotic therapy among patients treated for urinary tract infections (UTIs) in our ED., Methods: Retrospective cohort study conducted at a large tertiary teaching hospital. Participants included patients older than 18years of age who had a urine culture with growth of >100,000 colonies of E. coli. Demographic and therapeutic choices associated with inadequate empiric antibiotic therapy were explored. Antimicrobial susceptibility pattern of E. coli isolates recovered from ED patients were calculated, and stratified by gender and age., Results: A total of 300 unique patients had E. coli bacteriuria during the study period. Among patients who received at least one dose of antibiotic in the ED, variables independently associated with an increased risk of inadequate empiric therapy were age (relative risk [RR] 1.016; 95% confidence interval [CI] 1.001-1.031; P=0.032), male gender (RR 2.507; 95% CI 1.470-4.486; P=0.001), and use of fluoroquinolones (RR 2.128; 95% CI 1.249-3.624 P=0.005). Sub-group analysis of patients discharged from the ED showed that definitive therapy with nitrofurantoin decreased the risk of inadequate empiric antibiotic therapy by 80% (RR 0.202; CI 0.065-0.638; P=0.006). ED-level antibiograms showed differences in antimicrobial susceptibility of E. coli by age and gender., Conclusions: Development of ED-level antimicrobial susceptibility data and consideration of patients' clinical characteristics can help better guide selection of empiric antibiotic therapy for the treatment of UTIs., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background. Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection (ARI). Methods. A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI. Results. In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from $18,588 to $29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4-12.7 days, and attributable mortality was 6.5%. The societal costs were $10.7-$15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of $13.35 million in 2008 dollars in this patient cohort. Conclusions. The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs. [ABSTRACT FROM AUTHOR]