Clinical Infectious Diseases Advance Access published May 13, 2014

1  Antibiotic Susceptibility of Common Pediatric Uropathogens in the United States

Pranita D. Tamma1, Daniel J. Sklansky2, Debra L. Palazzi3, Sanjeev Swamy4, Aaron M. Milstone1 1

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Johns Hopkins University School of Medicine

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University of Wisconsin Hospital and Clinics

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Baylor College of Medicine

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Nemours Alfred I. duPont Hospital for Children

Department of Pediatrics, Division of Infectious Diseases, 200 North Wolfe Street, Suite 3155, Baltimore, Maryland 21287, Tel (443) 287-4099 Fax (410) 614-1491, [email protected]

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Alternate Corresponding Author: Aaron M. Milstone, M.D., M.H.S. Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, 200 North Wolfe Street, Suite 3155,

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Baltimore, Maryland 21287, Tel (443) 287-4099 Fax (410) 614-1491, [email protected]

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of  America. All rights reserved. For Permissions, please e‐mail: [email protected]

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Corresponding author: Pranita D. Tamma, MD, MHS, Johns Hopkins University School of Medicine,

2  Dear Editor, Urinary tract infections (UTIs) remain a common indication for antibiotic therapy in children1. They are frequently managed in the outpatient setting where availability of susceptibility results may be delayed, making

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selection of appropriate initial therapy important. We sought to evaluate susceptibility patterns of antibiotic agents used to treat UTIs in children by developing a pooled antibiogram of urinary isolates from pediatric hospitals across the United States.

described2. Susceptibility data were collected separately for institutions that have and have not incorporated the Clinical and Laboratory Standard Institution (CLSI) recommendations to lower cefazolin breakpoints from

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≤8 µg/ml to ≤2 µg/ml against Enterobacteriaceae3. Comparisons were made using chi-square analysis.

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Data were obtained from 43 hospitals (Table). The addition of clavulanate to amoxicillin increased activity against E. coli, the most common uropathogen isolated, from 49% to 75%. Ceftriaxone had the highest activity against E. coli at 97%. Cefazolin was active against 90% of E. coli isolates using a breakpoint of 8µg/ml and

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47% of isolates for institutions using a breakpoint of 2µg/ml (p

Antibiotic susceptibility of common pediatric uropathogens in the United States.

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