Journal article
Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement
Journal of antimicrobial chemotherapy, Vol.79(5), pp.1038-1044
03/14/2024
DOI: 10.1093/jac/dkae070
PMCID: PMC11491652
PMID: 38482607
Abstract
Urinary tract infections (UTIs) are commonly treated in the emergency department (ED), and unfortunately, resistance to first-line agents is increasing.
To characterize treatment of pyelonephritis in a nationally representative sample of ED patients and to identify patient- and treatment-specific factors associated with receiving initial inactive antibiotics.
We conducted a multicentre, observational cohort study utilizing the Emergency Medicine PHARMacotherapy Research NETwork (EMPHARM-NET), comprising 15 geographically diverse US EDs. All patients ≥18 years of age with a diagnosis of pyelonephritis between 2018 and 2020 were included. The primary endpoint was the proportion of patients who received initial inactive empirical antibiotic therapy and to identify predictive factors of inactive antibiotic therapy.
Of the 3714 patients evaluated, 223 had culture-positive pyelonephritis. Median patient age was 50.1 years and patients were mostly female (78.3%). Overall, 40.4% of patients received an IV antibiotic, most commonly ceftriaxone (86.7%). The most frequently prescribed antibiotics were cefalexin (31.8%), ciprofloxacin (14.3%), cefdinir (13.5%) and trimethoprim/sulfamethoxazole (12.6%). Overall, 10.3% of patients received initial inactive therapy. After adjustment in a multivariable analysis, long-acting IV antibiotic was predictive of inactive therapy (OR 0.23, 95% CI 0.07-0.83).
In our prospective, multicentre observational study, we found that only 40.4% of patients with pyelonephritis received empirical IV antibiotics in the ED, contributing to inactive therapy. Receipt of long-acting IV antibiotics was independently associated with a decreased rate of initial inactive therapy. This reinforces guideline recommendations to administer long-acting IV antibiotics empirically in the ED upon suspicion of pyelonephritis.
Details
- Title: Subtitle
- Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement
- Creators
- Megan A Rech - Loyola University Medical CenterBrett A Faine - University of IowaAlan E Gross - University of Illinois ChicagoPriyanka Vakkalanka - University of IowaCaitlin S Brown - Mayo ClinicStephanie J Harding - Wesley Medical CenterGiles Slocum - Rush University Medical CenterDavid Zimmerman - Duquesne UniversityAnne Zepeski - University of IowaStacey Rewitzer - Park Nicollet Methodist HospitalGavin T Howington - University of KentuckyMatt Campbell - Cleveland ClinicJordan Dawson - Denver Health Medical CenterCierra N Treu - NewYork–Presbyterian Brooklyn Methodist HospitalLucas Nelson - Park Nicollet Methodist HospitalMandy Jones - University of Kentucky HealthCareTara Flack - Methodist HospitalBlake Porter - University of Vermont Medical CenterPreeyaporn Sarangarm - University of New Mexico HospitalAlicia E Mattson - Mayo ClinicAbby Bailey - University of Kentucky HealthCareGregory Kelly - Robert Wood Johnson University HospitalDavid A Talan - Olive View-UCLA Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of antimicrobial chemotherapy, Vol.79(5), pp.1038-1044
- DOI
- 10.1093/jac/dkae070
- PMID
- 38482607
- PMCID
- PMC11491652
- NLM abbreviation
- J Antimicrob Chemother
- eISSN
- 1460-2091
- Grant note
- UL1TR002537 / National Center for Advancing Translational Sciences of the National Institutes of Health
- Language
- English
- Electronic publication date
- 03/14/2024
- Academic Unit
- Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984572459002771
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