1435. Urinary Tract Infections Due to Extended-Spectrum Β-Lactamase-Producing Bacteria in Hospitalized Children: Demographics, Risk Factors, Clinical Characteristics, Imaging and Treatment

Abstract Background Urinary tract infections (UTIs) are a common cause for hospitalization in children. Inadequate treatment can lead to long-term renal damage. AAP guidelines recommend third-generation cephalosporins as empiric therapy. However, the incidence of community-acquired multiresistant, extended-spectrum β-lactamase (ESBL)-producing pathogens is rising. More research is needed to evaluate risk factors and management of ESBL UTI in children. Methods A case–control retrospective study was conducted at a tertiary care children’s hospital from July 2014 to December 2017. Hospitalized, non-ICU patients aged 0–18 years with UTI and urine culture positive for potentially ESBL-producing organisms were retrieved. Of the 1301 cultures reviewed, 106 cases (UTI+ESBL) were identified and 208 controls (UTI+non-ESBL) were randomly selected. We compared demographics, risk factors, clinical characteristics and treatment between both groups. Results Both groups had similar demographics, except for a higher median age for ESBL patients (3 vs. 0 years). ESBL patients were significantly more likely (P < 0.001) to have recent antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities. Both groups had similar clinical presentations and laboratory results. ESBL patients had more VCUGs performed (59.4% vs. 38%), but the prevalence of high-grade VUR was similar in both groups. ESBL patients had longer course of IV antibiotics and length of stay (mean 6 vs. 3 days). Although 59.4% of ESBL patients received inappropriate initial antibiotics based on culture susceptibilities, 77.4% of these patients clinically improved with initial therapy. Conclusion Our results support previous studies demonstrating that prior antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities are risk factors for ESBL UTI. When these are encountered, the suspicion for ESBL should be higher and may guide antibiotic therapy pending culture results. Given the similar prevalence of high-grade VUR in both groups, the presence of ESBL UTI alone should not be an indication to obtain a VCUG. Finally, a subgroup of patients with ESBL UTI might be clinically responsive to third-generation cephalosporins, despite in vitro resistance. Disclosures All authors: No reported disclosures.

Download Full-text

Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics

Journal of Renal Injury Prevention ◽

10.34172/jrip.2022.02 ◽

2021 ◽

Vol 11 (1) ◽

pp. e2-e2

Author(s):

Manijeh Kahbazi ◽

Parsa Yousefichaijan ◽

Danial Habibi ◽

Somaie Nejabat ◽

Amirreza Najmi ◽

...

Keyword(s):

Urinary Tract ◽

Recurrence Rate ◽

Urine Analysis ◽

Third Generation ◽

Extended Spectrum ◽

First Choice ◽

Febrile Uti ◽

History Of ◽

Tract Infections ◽

Third Generation Cephalosporins

Introduction: The prevalence of urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL)-producing bacteria is rising, which needs more potent antibiotics, such as carbapenems. Objectives: To evaluate the clinical and laboratory differences between ESBL-positive and ESBL-negative bacteria in febrile UTI in children between one month to seven years to indicate prognostic parameters for ESBL+ UTI and to suggest appropriate antibiotic treatment. Patients and Methods: This cross-sectional study investigated 282 patients diagnosed with the first febrile UTI. The participants were assigned to ESBL-positive and ESBL-negative UTI groups. The groups were compared based on their clinical and laboratory characteristics and outcomes; the infant group was assessed separately (with the onset age of <3 months). Results: The ESBL UTI was detected in 10.2% of the cases with a history of more frequent hospitalization (P=0.002), longer hospitalization (P=0.04), higher recurrence rate (P=0.003), and more red blood cell count in urine analysis findings (P=0.02). In the antimicrobial susceptibility assay, the ESBL-positive UTI group indicated resistance to third-generation cephalosporins; nevertheless, 93.1% of the cases responded clinically. The infant group showed 13% of the patients with ESBL-positive UTI that was correlated with a history of longer preonset hospital stay (P=0.001), elevated C-reactive protein (CRP) concentration (P=0.002), and elevated recurrence rate (P=0.03), compared to the older group. Conclusion: The ESBL UTI should be further considered due to the resulted recurrence rate. The antimicrobial sensitivity assay indicated resistance to third-generation cephalosporins; however, these drugs are applied as the first choice due to the high response rate. Aminoglycosides are applicable as second choice drugs prior to initiating the use of carbapenems, if third-generation cephalosporins did not indicate bactericidal impacts on ESBL UTI.

Download Full-text

Risk Factors for Community Acquired Extended-Spectrum Β-lactamase (ESBL) Producing Enterobacteriaceae Urinary Tract Infections (UTIs)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.827 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S345-S345

Author(s):

Dheeraj Goyal ◽

Kristin Dascomb ◽

Peter S Jones ◽

Bert K Lopansri

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Catheter ◽

Univariate Analysis ◽

Prior History ◽

Factors Associated ◽

Extended Spectrum ◽

History Of ◽

Enterobacteriaceae Infections ◽

Tract Infections

Abstract Background Community-acquired extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infections pose unique treatment challenges. Identifying risk factors associated with ESBL Enterobacteriaceae infections outside of prior colonization is important for empiric management in an era of antimicrobial stewardship. Methods We randomly selected 251 adult inpatients admitted to an Intermountain healthcare facility in Utah with an ESBL Enterobacteriaceae urinary tract infection (UTI) between January 1, 2001 and January 1, 2016. 1:1 matched controls had UTI at admission with Enterobacteriaceae but did not produce ESBL. UTI at admission was defined as urine culture positive for > 100,000 colony forming units per milliliter (cfu/mL) of Enterobacteriaceae and positive symptoms within 7 days prior or 2 days after admission. Repeated UTI was defined as more than 3 episodes of UTI within 12 months preceding index hospitalization. Cases with prior history of ESBL Enterobacteriaceae UTIs or another hospitalization three months preceding the index admission were excluded. Univariate and multiple logistic regression techniques were used to identify the risk factors associated with first episode of ESBL Enterobacteriaceae UTI at the time of hospitalization. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, presence of a urinary catheter at time of admission, and prior exposure to outpatient antibiotics within past one month were found to be significantly associated with ESBL Enterobacteriaceae UTIs. When controlling for age differences, severity of illness and co-morbid conditions, history of repeated UTIs (adjusted odds ratio (AOR) 6.76, 95% confidence interval (CI) 3.60–13.41), presence of a urinary catheter at admission (AOR 2.75, 95% CI 1.25 – 6.24) and prior antibiotic exposure (AOR: 8.50, 95% CI: 3.09 – 30.13) remained significantly associated with development of new ESBL Enterobacteriaceae UTIs. Conclusion Patients in the community with urinary catheters, history of recurrent UTIs, or recent antimicrobial use can develop de novo ESBL Enterobacteriaceae UTIs. Disclosures All authors: No reported disclosures.

Download Full-text

Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections

African Health Sciences ◽

10.4314/ahs.v21i1.28 ◽

2021 ◽

Vol 21 (1) ◽

pp. 214-9

Author(s):

Ertugrul Guclu ◽

Fikret Halis ◽

Elif Kose ◽

Aziz Ogutlu ◽

Oğuz Karabay

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Multidrug Resistant ◽

Antibiotic Usage ◽

Advanced Age ◽

History Of ◽

Tract Infections

Background: Urinary tract infections (UTIs) are one of the most seen infection among community. Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI. Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.

Download Full-text

Community acquired urinary tract infection: etiology and bacterial susceptibility

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502003001200012 ◽

2003 ◽

Vol 18 (suppl 5) ◽

pp. 33-36 ◽

Cited By ~ 7

Author(s):

José Anastácio Dias Neto ◽

Antonio Carlos Pereira Martins ◽

Leonardo Dias Magalhães da Silva ◽

Ricardo Brianezi Tiraboschi ◽

André Luis Alonso Domingos ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Severe Disease ◽

Antibacterial Drug ◽

Third Generation ◽

Antibacterial Susceptibility ◽

Tract Infections ◽

Epidemiological Characteristics ◽

Third Generation Cephalosporins

PURPOSE: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. OBJECTIVE: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. METHODS: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. RESULTS: The mean age of the patients in this study was 45.34 ± 23.56 (SD) years. There were 242 (60.2%) females and 160 (39.8%) males. The most commonly isolated organism was Escherichia coli (58%). Klebsiella sp. (8.4%) and Enterococcus sp.(7.9%) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37% were sensitive to ampicillin, 51% to cefalothin and 52% to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96%), ceftriaxone (90%), amikacin (90%), gentamicin (88%), levofloxacin (86%), ciprofloxacin (73%), nitrofurantoin (77%) and norfloxacin (75%). CONCLUSION: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

Download Full-text

Abstract P252: Duration and Life-stage of Antibiotic Use and Risk of Cardiovascular Disease in Women

Circulation ◽

10.1161/circ.135.suppl_1.p252 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Yoriko Heianza ◽

Yan Zheng ◽

Wenjie Ma ◽

Tiange Wang ◽

Dianjianyi Sun ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Life Stage ◽

Antibiotic Use ◽

Healthy Eating Index ◽

Increased Risk ◽

Antibiotics Use ◽

History Of ◽

Traditional Risk Factors ◽

Tract Infections

Background and Aims: Growing data suggest that antibiotic use, which may alter the gut microbiome, is related to risk of cardiovascular disease (CVD) and mortality. However, evidence from prospective cohort studies is still scarce; and no large prospective study has investigated associations between cumulative antibiotic use during adulthood and risk of CVD. We aimed to examine duration of antibiotic use and risk of CVD among apparently healthy women from the Nurses’ Health Study (NHS). Methods: This study included 36,922 women without history of myocardial infarction (MI), angina pectoris, stroke, or cancer in the NHS and with available data on total days of antibiotics use per year (0 to <15 days, 15 days to <2 months, or 2 months or more) during ages 20-39, 40-59 and after age 60, as reported on the 2004 questionnaire. Incidence of CVD (MI or stroke) over 8 years was assessed. Hazard ratios (HRs) were estimated as categories of duration of use compared with the none to <15 days per year group, using multivariate-adjusted Cox proportional hazards model including traditional risk factors (such as demographic variables, hypertension, diabetes, hypercholesterolemia, smoking, physical activity, Alternative Healthy Eating Index score, body mass index, aspirin, and anti-inflammatory medication), and reasons for antibiotics use (respiratory infection, urinary tract infections, acne or rosacea, chronic bronchitis, or dental), as well as other medications (such as H2 blockers, proton pump inhibitors), and other diseases (such as lung or kidney disease). Results: As compared to women with “none to <15 days per year of use” during age 40-59 y, those with a history of antibiotics use “15 days to < 2 months” or “2 months or more” had a significantly increased risk of CVD with an adjusted hazard ratio (HR [95%CI])_ of 1.19 (1.03, 1.38) and 1.34 (1.08, 1.66), respectively. Reported use of antibiotics for 2 months or more per year after age 60 was also associated with a HR of 1.24 (1.02, 1.51) for CVD. A longer exposure of antibiotics use was more strongly associated with increased risk of stroke than MI Antibiotic use during young adulthood (age 20-39) was not significantly associated with elevated risk of CVD. Conclusions: Our results suggest greater duration of exposure to antibiotics in middle- and older adulthood may be related to an increased risk of future CVD, independent of traditional risk factors.

Download Full-text

Carriage of Staphylococcus aureus and of Gram-Negative Bacilli Resistant to Third-Generation Cephalosporins in Cirrhotic Patients A Prospective Assessment of Hospital-Acquired Infections

Infection Control and Hospital Epidemiology ◽

10.1086/501929 ◽

2001 ◽

Vol 22 (7) ◽

pp. 427-432 ◽

Cited By ~ 31

Author(s):

Catherine Dupeyron ◽

Bernard Campillo ◽

Nicole Mangeney ◽

Muriel Bordes ◽

Jean-Philippe Richardet ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Third Generation ◽

Gram Negative ◽

Bacterial Peritonitis ◽

Prospective Assessment ◽

Cirrhotic Patients ◽

Tract Infections ◽

Third Generation Cephalosporins

AbstractObjective:To study the relation between Staphylococcus aureus nasal and stool colonization, stool carriage of gram-negative bacilli resistant to third-generation cephalosporins (CephR), and subsequent infections during hospitalization.Design:Prospective study.Patients:551 cirrhotic patients with 589 consecutive hospital stays. All patients were screened within 48 hours of admission; 589 nasal swabs, 417 stool specimens, and 589 urine samples were analyzed.Results:Carriage rates were 18.8% for methicillin-sensitive S aureus (MSSA), 16.3% for methicillin-resistant S aureus (MRSA), and 13.7% for CephR. We observed 87 episodes of spontaneous bacterial peritonitis, 63 cases of bacteremia, and 167 urinary tract infections occurred. Only 1 case of bacteremia and 4 urinary tract infections due to CephR occurred in patients carrying the same organism in their stools. The risk of MRSA ascitic fluid infections, bacteremia, and urinary tract infections was 3.1% versus 1% (not significant), 8.3% versus 0.8% (P<.001), and 11.4% versus 0.6% (P<.001) in carriers and noncarriers, respectively. Pulsed-field gel electrophoresis (PFGE) of isolates from 16 patients infected by MSSA (3 cases) and MRSA (13 cases) demonstrated that the colonizing strains matched the invasive strains in the 3 MSSA cases and in 8 of 13 MRSA cases.Conclusion:Carriage of CephR strains is not associated with subsequent infection by these organisms in hospitalized cirrhotic patients. In contrast, MRSA carriage was an important risk factor for MRSA bacteremia and urinary tract infection.

Download Full-text

Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

CJEM ◽

10.2310/8000.2012.120666 ◽

2012 ◽

Vol 14 (05) ◽

pp. 295-305 ◽

Cited By ~ 17

Author(s):

Lyne Filiatrault ◽

Rachel M. McKay ◽

David M. Patrick ◽

Diane L. Roscoe ◽

Grahame Quan ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Antibiotic Resistance ◽

Risk Factor ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Tertiary Care ◽

Antibiotic Use ◽

Adult Females ◽

Tract Infections

ABSTRACTIntroduction:We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.Methods:We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.Results:Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases.Escherichia coliaccounted for 82.3% of all UTIs, whereasStaphylococcus saprophyticusaccounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16–9.62) and TMP-SMX (OR 4.02, 95% CI 1.48–10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.Conclusions:E. coliwas the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.

Download Full-text

Etiological characteristic and risk factors of ESBL-Urinary Tract Infections: A nomogram had been built and Urologist should act in time

10.21203/rs.3.rs-31324/v1 ◽

2020 ◽

Author(s):

Yi Wei ◽

Chengjun Yu ◽

Tianxing Zhao ◽

Tao Lin ◽

Dawei He ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Significant Risk ◽

Significant Risk Factor ◽

Antibiotic Use ◽

Clinical Microbiology Laboratory ◽

Neurologic Disorder ◽

Extended Spectrum Beta Lactamase ◽

Tract Infections

Abstract Background: The presence of urinary tract infection (UTI) due to Extended-Spectrum Beta-Lactamase (ESBL)-producing bacteria is reported increased. Aim to study the most frequent uropathogens and the antibiotic susceptibility patterns of them in children and identify whether urodynamic change, underlying neurologic disorders and undernourishment were independent risk factors for ESBL positive UTI which is unclear. Methods: We retrospectively reviewed microbial etiologies and antimicrobial resistance among patients experiencing UTI events in the urology ward of Chongqing Medical University Afflicated Chlidren's Hospital from January 1994 and December 2019. All strains were cultured and identified by the Clinical Microbiology Laboratory. Results: A total of 854 patients with UTI over a 26-years period were evaluated and Escherichia coli was the most common pathogen. During the study period, the proportion of UTI cases attributed to Enterococci increased significantly. Susceptibilities to carbapenems and amikacin decreased significantly, indicating increased antibiotic resistance of pathogens associated with UTI. Interestingly, the susceptibilities to piperacillin/tazobactam have increased. 72.64% were caused by ESBL bacteria and ESBL-producing bacteria increased significantly. ESBL (+) and ESBL (-) UTI were compared and there were no significant differences in the clinical presentation between gender, side of the lesion and urodynamic results. Significant potential risk factors of ESBL-UTI were presence of congenital urological abnormalities, vesicoureteral reflux, neurologic disorder, age <12months, fever and previous use of antibiotics in the last 3 months. On logistic regression analysis, underlying neurologic disorder (OR =8, CI 1.845-34.695) and history of previous antibiotics administration in the last 3 months (OR =4.764, CI 3.114-7.289) were identified as an independent significant risk factor for ESBL- UTI. The nomogram generated was well calibrated for all predictions of ESBL+ probability, and the accuracy of the model nomogram measured by Harrell’s C statistic (C-index) was 0.741. Conclusions: The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI, and urologist should act timely. Our data will greatly assist physicians recognizing the risk factors of ESBL-UTI and optimising antibiotic use.

Download Full-text

Risk Factors for Antibiotic Resistant Urinary Pathogens in Patients Discharged From the Emergency Department

Hospital Pharmacy ◽

10.1177/00185787211046851 ◽

2021 ◽

pp. 001857872110468

Author(s):

Stephanie L. Barré ◽

Erin R. Weeda ◽

Andrew J. Matuskowitz ◽

Gregory A. Hall ◽

Kyle A. Weant

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Antibiotic Use ◽

Patient Specific ◽

Lifetime History ◽

Specific Risk ◽

History Of ◽

Inappropriate Antibiotics

Purpose: Urinary tract infections (UTIs) are one of the most common indications for antimicrobial use in the emergency department (ED). Appropriate empiric selection is crucial to ensure optimal care while limiting broad-spectrum antibiotic use. The primary objective of this study was to evaluate the relationship between patient-specific risk factors and drug resistant urinary pathogens in patients discharged from the ED and followed by Emergency Medicine Pharmacists (EMPs). Methods: This was a single-center, retrospective chart review of adult (≥18 years old) patients with positive urine cultures discharged from the ED. The association between risk factors and pathogen resistance to ≥1 classes of antibiotics was evaluated using multivariate logistic regression. Risk factors included the following: hospitalization within the previous 30 days, intravenous antibiotic use within 90 days, diabetes, clinical atherosclerotic cardiovascular disease, psychiatric disorder, dementia, current antibiotic use for any indication, previous lifetime history of UTIs, indwelling or intermittent catheterization, hemodialysis, previous lifetime history of a urologic procedure, urinary tract abnormality, immunosuppressive disease or medications, current residence in a nursing or rehabilitation facility, and history of a multidrug resistant organism (MDRO). Results: A total of 1018 patients were included. There was an increase in the odds of antibiotic resistance in patients with cystitis and ≥2 risk factors (Odds Ratio [OR] = 1.70, 95% CI = 1.24-2.32). In those with pyelonephritis, there was a non-significant increase in the odds of resistance for those with ≥2 risk factors (OR = 1.83, 95% CI = 0.98-3.42). Patients with pyelonephritis discharged on inappropriate antibiotics were more likely to return to the ED within 30 days ( P = .03). Conclusions: For patients with cystitis discharged from the ED, those with ≥2 patient-specific risk factors had significantly increased odds of antibiotic resistance. Patients with pyelonephritis, but not cystitis, who were discharged on inappropriate antibiotics were more likely to return to the ED within 30 days. In conjunction with an EMP culture follow-up program, the identification of risk factors for antimicrobial resistance can be used to design more patient-specific empiric antibiotic selections.

Download Full-text