• Sarah Jorgensen, Mira Zurayk, Samantha Yeung, Jill Terry, Maureen Dunn, Paul Nieberg, and Annie Wong-Beringer.
• 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.
• Am J Emerg Med. 2018 Jan 1; 36 (1): 12-17.

BackgroundOptimal 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.MethodsA 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).ResultsWe 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).ConclusionsERV 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.Copyright © 2017 Elsevier Inc. All rights reserved.

33 keywords...

hide…