Department of Pharmacy, Mount Sinai Beth Israel, New York, NY, United States.
Department of Pharmacy, Mount Sinai Beth Israel, New York, NY, United States.
Am J Emerg Med. 2021 Jul;45:464-471. doi: 10.1016/j.ajem.2020.09.061. Epub 2020 Sep 30.
Urinary tract infections (UTI) are a common reason for emergency department (ED) and urgent care (UC) visits. Fluoroquinolones (FQ) are frequently prescribed for treatment of UTI in the outpatient setting; however, data evaluating prescribing patterns after FDA safety warnings is limited, especially in UC. The study goal was to investigate and compare antimicrobial prescribing for UTIs in a single-site ED and an off-site UC in an urban, academic health system. This retrospective study included patients presenting with a UTI to the ED or UC between January and June 2018. Those 18 years or older with uncomplicated, complicated UTI, or pyelonephritis were included. Exclusion criteria were catheter-related UTI, urinary tract abnormalities, immunocompromised, or hospitalization. Primary outcome was FQ prescribing rate for all UTI in the ED and UC. Secondary outcomes were rates of non-FQ prescribing, re-presentation, bug-drug mismatch, and treatment durations. 184 patients were included. FQ prescribing rate was similar in ED and UC (21.2% vs. 16.3%, p = 0.4). Non-FQs prescribed in ED and UC were nitrofurantoin (20.2% vs 53.6%), beta-lactams (46.1% vs 22.6%), and trimethoprim/sulfamethoxazole (12.5% vs. 5%). A longer than recommended duration was identified in 46.3% UC patients compared to 21.2% ED patients. Thirty-day re-presentation with persistent UTI symptoms occurred more frequently in the ED compared to UC (13.5% vs. 7.5%). Predictors of FQ prescribing on logistic regression were male, recurrent UTI, and malignancy. FQ prescribing rate for UTI treatment was low with no difference between ED and UC. Opportunity exists to improve treatment duration and antimicrobial choice.
尿路感染（UTI）是急诊科（ED）和紧急护理（UC）就诊的常见原因。氟喹诺酮类（FQ）常用于门诊治疗 UTI；然而，在 FDA 安全警告后评估处方模式的数据有限，尤其是在 UC 中。该研究的目的是调查和比较单一地点 ED 和非现场 UC 中 UTI 的抗菌药物处方，这是一个城市学术医疗系统。这项回顾性研究包括 2018 年 1 月至 6 月期间在 ED 或 UC 就诊的 UTI 患者。年龄在 18 岁及以上，患有单纯性、复杂性 UTI 或肾盂肾炎的患者被纳入研究。排除标准为导管相关性 UTI、尿路异常、免疫功能低下或住院患者。主要结局是 ED 和 UC 中所有 UTI 的 FQ 处方率。次要结局是非 FQ 处方率、再次就诊率、病菌-药物不匹配率和治疗持续时间。共纳入 184 例患者。ED 和 UC 的 FQ 处方率相似（21.2% vs. 16.3%，p=0.4）。ED 和 UC 中开的非 FQ 药物分别为呋喃妥因（20.2% vs. 53.6%）、β-内酰胺类（46.1% vs. 22.6%）和甲氧苄啶/磺胺甲恶唑（12.5% vs. 5%）。与 ED 患者（21.2%）相比，UC 患者中有 46.3%的治疗时间长于推荐时间。ED 患者中持续 UTI 症状的 30 天再就诊率高于 UC（13.5% vs. 7.5%）。逻辑回归分析表明，FQ 处方的预测因素为男性、复发性 UTI 和恶性肿瘤。FQ 用于 UTI 治疗的处方率较低，ED 和 UC 之间无差异。有机会改善治疗持续时间和抗菌药物选择。
