Brochu Jessica M, Gunaga Satheesh, Kenney Rachel M, Veve Michael P
Critical Care and Pharmacy, Henry Ford Health System, Detroit, USA.
Emergency Medicine, Henry Ford Wyandotte Hospital and Envision Healthcare, Wyandotte, USA.
Cureus. 2025 May 31;17(5):e85138. doi: 10.7759/cureus.85138. eCollection 2025 May.
Introduction The treatment of extended-spectrum β-lactamase (ESBL)-producing urinary tract infections (UTIs) in the emergency department (ED) is challenging due to the limited oral treatment options available. The purpose of this study was to describe the treatment and outcomes of ESBL UTIs in the ED and to determine risk factors associated with secondary UTI-related unplanned healthcare encounters. Methods This was an institutional review board (IRB)-approved, retrospective cohort study of patients discharged from the ED with an ESBL UTI. The primary outcome was any UTI-related unplanned healthcare encounter within 30 days of the index ED visit. Unplanned healthcare encounters included phone/virtual visits, clinic visits, ED visits, and hospitalizations. Patients of ≥18 years of age treated for symptomatic UTI were included. Logistic regression was used to identify exposures independently associated with UTI-related unplanned healthcare encounters. Results A total of 162 patients were included, of which 103 (64%) experienced an unplanned healthcare encounter. The most common UTIs were complicated lower (71, 44%), complicated upper (57, 35%), catheter-related (24, 15%), and uncomplicated cystitis (10, 6%). Nitrofurantoin demonstrated to have in vitro activity in 121 (75%) patients, aminoglycosides in 117 (72%) patients, trimethoprim/sulfamethoxazole (TMP/SMX) in 66 (41%) patients, and fluoroquinolones in 62 (38%) patients. Of the 103 patients who experienced an unplanned healthcare encounter, 76 (74%) received inactive empiric antibiotic treatment. Oral β-lactams were most commonly prescribed, accounting for 66 (41%) of all initial prescriptions. Of the 81 patients with lower UTI, only 20 (25%) received a prescription for nitrofurantoin. Factors associated with UTI-related unplanned healthcare encounters included chronic kidney disease (CKD) (adjusted odds ratio {adjOR}, 3.4; 95% confidence interval {CI}, 1.2-9.5) and empiric oral β-lactam use (adjOR, 3.2; 95% CI, 1.5-6.6). Conclusions Patients with CKD or who received empiric oral β-lactam treatment more commonly experienced an ESBL UTI-related unplanned healthcare encounter. Prescribing first-line therapy with nitrofurantoin for lower UTI is a potential area for improvement.
由于可用的口服治疗选择有限，急诊科（ED）中治疗产超广谱β-内酰胺酶（ESBL）的尿路感染（UTI）具有挑战性。本研究的目的是描述急诊科中产ESBL的UTI的治疗和结局，并确定与UTI相关的计划外医疗接触相关的危险因素。方法：这是一项经机构审查委员会（IRB）批准的回顾性队列研究，研究对象为从急诊科出院的产ESBL的UTI患者。主要结局是在首次急诊科就诊后30天内发生的任何与UTI相关的计划外医疗接触。计划外医疗接触包括电话/虚拟就诊、门诊就诊、急诊科就诊和住院治疗。纳入年龄≥18岁且因有症状的UTI接受治疗的患者。采用逻辑回归分析来确定与UTI相关的计划外医疗接触独立相关的暴露因素。结果：共纳入162例患者，其中103例（64%）经历了计划外医疗接触。最常见的UTI类型为复杂性下尿路感染（71例，44%）、复杂性上尿路感染（57例，35%）、导管相关感染（24例，15%）和非复杂性膀胱炎（10例，6%）。呋喃妥因在121例（75%）患者中显示有体外活性，氨基糖苷类在117例（72%）患者中显示有体外活性，甲氧苄啶/磺胺甲恶唑（TMP/SMX）在66例（41%）患者中显示有体外活性，氟喹诺酮类在62例（38%）患者中显示有体外活性。在103例经历计划外医疗接触的患者中，76例（74%）接受了无效的经验性抗生素治疗。口服β-内酰胺类药物是最常用的处方药物，占所有初始处方的66例（41%）。在81例下尿路感染患者中，只有20例（25%）接受了呋喃妥因处方。与UTI相关的计划外医疗接触相关的因素包括慢性肾脏病（CKD）（调整比值比{adjOR}，3.4；95%置信区间{CI}，1.2 - 9.5）和经验性口服β-内酰胺类药物的使用（adjOR，3.2；95% CI，1.5 - 6.6）。结论：患有CKD或接受经验性口服β-内酰胺类药物治疗的患者更常经历与产ESBL的UTI相关的计划外医疗接触。为下尿路感染开具呋喃妥因一线治疗药物是一个潜在的改进领域。
