• Kirstin J Kooda, Maria Rudis, Kristin Mara, Casey Clements, and Fernanda Bellolio.
• Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
• J Emerg Med. 2021 Jan 1; 60 (1): 8-16.

BackgroundUrinary tract infection (UTI) is the second most common infection requiring intensive care unit (ICU) admission in emergency department (ED) patients. Optimal empiric management for health care-associated (HCA) UTI is unclear, particularly in the critically ill.ObjectiveTo compare clinical failure of broad vs. narrow antibiotic selection in the ED for patients presenting with HCA UTI admitted to the ICU.MethodsObservational cohort of patients started on empiric antibiotic for UTI with at least one HCA risk factor (recurrent UTI, chronic urinary catheter or dialysis, urologic procedures, previous antibiotic exposure, hospitalization, or group facility residence). Broad antibiotics covered Pseudomonas spp. and extended-spectrum beta-lactamase. Clinical failure was a composite of multiorgan dysfunction (MODS) by day 2 and in-hospital mortality. Secondary outcomes were length of stay (LOS), readmission, recurrent infection, development of multidrug-resistant organisms, and Clostridium difficile infection. Associations were reported with odds ratios (OR) and 95% confidence intervals (CI).ResultsThere were 272 patients included; 196 (72.1%) received broad and 76 (27.9%) received narrow therapy. There was no association between antibiotic selection and clinical failure (OR 1.05, 95% CI 0.5-2.25, p = 0.89) or between antibiotic selection and number of HCA risk factors (OR 0.98, 95% CI 0.73-1.31, p = 0.87). There was an association between clinical failure and MODS on ICU admission (OR 9.14, 95% CI 4.70-17.78, p < 0.001). Hospital LOS and readmission did not differ between antibiotic groups.ConclusionInitial empiric broad or narrow antibiotic coverage in HCA UTI patients who presented to the ED and required ICU admission had similar clinical outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

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