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Am J Emerg Med. 2018 Jan;36(1):12-17. doi: 10.1016/j.ajem.2017.06.041. Epub 2017 Jun 21.

Risk factors for early return visits to the emergency department in patients with urinary tract infection.

Author information

1
Department of Pharmacy, Huntington Hospital, 100 W California Blvd, Pasadena, CA 91105, United States; University of Southern California, School of Pharmacy, 1985 Zonal Ave, Los Angeles, CA 90089, United States.
2
Department of Pharmacy, Huntington Hospital, 100 W California Blvd, Pasadena, CA 91105, United States.
3
University of Southern California, School of Pharmacy, 1985 Zonal Ave, Los Angeles, CA 90089, United States.
4
Division of Emergency Medicine, Department of Medicine, Huntington Hospital, 100 W California Blvd, Pasadena, CA 91105, United States.
5
Division of Infectious Diseases, Department of Medicine, Huntington Hospital, 100 W California Blvd, Pasadena, CA 91105, United States.
6
Department of Pharmacy, Huntington Hospital, 100 W California Blvd, Pasadena, CA 91105, United States; University of Southern California, School of Pharmacy, 1985 Zonal Ave, Los Angeles, CA 90089, United States. Electronic address: anniew@usc.edu.

Abstract

BACKGROUND:

Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI.

METHODS:

A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30days (ERVs).

RESULTS:

We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (P<0.05) in patients with the following: age≥65years; pregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature≥38 °C heart rate>100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible). Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P=0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P=0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; P<0.05).

CONCLUSIONS:

ERV in UTI patients may be minimized by using ED-source specific antibiogram data to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up.

KEYWORDS:

Emergency department; Return visits; Urinary tract infection

PMID:
28655424
DOI:
10.1016/j.ajem.2017.06.041
[Indexed for MEDLINE]

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