Yu Jessica, Koolstra Christine, Smit De Villiers, Mitra Biswadev
Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2025 Oct;37(5):e70130. doi: 10.1111/1742-6723.70130.
Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.
A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018-2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.
There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was E. coli, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1-6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.
Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. E. Coli in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.
急性肾盂肾炎（APN）是急诊科就诊患者的常见诊断。在急诊科，患者接受经验性抗生素治疗。随着全球抗菌药物耐药性的上升，尚不清楚患者是否正在接受针对APN病原体的合适经验性抗生素治疗。本研究的目的是描述引起APN的病原体，并评估当前经验性抗生素的选择是否合适。
对墨尔本大都市一家成人三级转诊医院5年期间（2018 - 2022年）出院诊断为APN的患者进行单中心回顾性研究。从ICD - 10出院诊断中确定符合条件的病例。通过明确的病历审查提取人口统计学、培养出的微生物和抗生素治疗方案。
纳入557例APN患者，初始评估后培养了569份尿液样本。培养出的最常见病原体是大肠杆菌，在232份（40.8%）培养结果中被鉴定出来。有26例（4.7%；95%置信区间：3.1 - 6.6）患者在急诊科接受了不适当的抗生素治疗。这种情况最常发生在开具氨苄西林或阿莫西林单药治疗时。76例（13.6%）患者出院时使用了不适当的抗生素。这种情况最常发生在出院时未开具抗生素的情况下。
大多数针对APN的经验性抗生素处方是合适的，且对培养出的微生物敏感。尿液样本中的大肠杆菌通常对阿莫西林、氨苄西林或甲氧苄啶耐药。严格遵守国家临床指南可进一步降低不适当抗生素处方率。
