Jorgensen Sarah, Zurayk Mira, Yeung Samantha, Terry Jill, Dunn Maureen, Nieberg Paul, Wong-Beringer Annie
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.
Department of Pharmacy, Huntington Hospital, 100 W California Blvd, Pasadena, CA 91105, United States.
Am J Emerg Med. 2018 Jan;36(1):12-17. doi: 10.1016/j.ajem.2017.06.041. Epub 2017 Jun 21.
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.
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).
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).
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.
由于急诊室（ED）患者周转快、护理连续性降低以及在缺乏微生物学数据的情况下做出治疗决策，因此对急诊室尿路感染（UTIs）进行最佳管理具有挑战性。我们试图确定急诊室中接受UTI治疗的患者复诊的风险因素。
通过国际疾病分类第9/10版代码随机抽取350例成年急诊室UTI患者进行回顾。从病历中提取相关数据，并在30天内有或无急诊室复诊（ERVs）的患者之间进行比较。
我们确定了51例（15%）有59次ERVs的患者，其中6%在72小时内复诊。近一半的ERVs（47%）与UTI相关，33%的ERV患者需要住院治疗。以下患者的ERVs明显更有可能发生（P<0.05）：年龄≥65岁；怀孕；住在专业护理机构；患有痴呆症；患有精神疾病；患有梗阻性尿路病；有医疗接触史；体温≥38°C、心率>100；以及患有菌血症。大肠杆菌是最常见的尿路病原体（70%），除呋喃妥因外（99%敏感）两组中大多数口服抗生素的敏感率均低于80%。头孢氨苄是最常用的抗生素（51%对44%；P=0.32）。头孢氨苄的细菌-药物不匹配在ERV患者中更常见（41%对15%；P=0.02）。ERV患者的培养随访频率较低（75%对100%；P<0.05）。
通过使用急诊室来源的特定抗菌谱数据来指导经验性治疗决策，并针对有风险的患者进行出院后随访，可将UTI患者的ERVs降至最低。
