Effects of an Initial Single Dose of Intravenous Antibiotics on Emergency Department Revisits Among Elderly Patients with Urinary Tract Infections
Urology Journal,
Vol. 20 No. 02 (2023),
27 February 2023
,
Page 135-140
https://doi.org/10.22037/uj.v20i02.7372
Abstract
Purpose: Urinary tract infection (UTI) is the second most common infectious disease among older adults. It is important that the treatment strategy used for older patients with UTIs in the emergency department (ED) be adequate. The effectiveness of an initial single dose of intravenous antibiotics in the ED for treating UTIs has not been extensively studied. Therefore, we investigated the clinical outcomes of single-dose intravenous antibiotic administration before discharge from the ED in elderly patients with UTIs.
Materials and Methods: This retrospective study was conducted among patients who visited two academic tertiary hospitals in Seoul, South Korea. We included all patients older than 65 years of age with UTI who visited the ED and were directly discharged between 1 January and 31 December 2019 (n = 429). The patients were divided into two groups according to whether they received a single dose of intravenous antibiotics before ED discharge.
Results: Patients who received intravenous antibiotics had a higher 72-hour revisit rate (43 [15.4%] vs 10 [6.7%], p = .009) and a longer mean duration of therapy (total days of antibiotics use) (11 [4.00 – 15.00] vs 5 [3.00 – 11.00], p < .001) than patients who received only oral antibiotics. However, the rate of admission after revisits did not differ significantly between the groups (27 [62.8%] vs 5 [50.0%], p = .492).
Conclusion: Older patients with severe UTIs were prescribed intravenous antibiotics in the ED. Decisions on admission or discharge should be made carefully for older patients with UTIs who are prescribed intravenous antibiotics in the ED.
- administration, intravenous
- aged
- anti-bacterial agents
- emergency department
- infusions, intravenous
- infusions, parenteral
- urinary tract infection
How to Cite
References
Rowe TA, Juthani-Mehta M. Diagnosis and management of urinary tract infection in older adults. Infect Dis Clin North Am. 2014;28(1):75-89. https://doi.org/10.1016/j.idc.2013.10.004 PMID:24484576
Gharbi M, Drysdale JH, Lishman H, et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ. 2019;364:l525. https://doi.org/10.1136/bmj.l525 PMID:30814048
Kang CI, Kim J, Park DW, et al. Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections. Infect Chemother. 2018;50(1):67-100. https://doi.org/10.3947/ic.2018.50.1.67 PMID:29637759
Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. https://doi.org/10.1093/cid/ciq257 PMID:21292654
Poh XE, Wu KH, Chen CC, Huang JB, Cheng FJ, Chiu IM. Outcomes for Patients with Urinary Tract Infection After an Initial Intravenous Antibiotics Dose Before Emergency Department Discharge. Infect Dis Ther. 2021;10(3):1479-1489. https://doi.org/10.1007/s40121-021-00469-9 PMID:34121165
Chaudhari PP, Monuteaux MC, Bachur RG. Emergency Department Revisits After an Initial Parenteral Antibiotic Dose for UTI. Pediatrics. 2018;142(3):142. https://doi.org/10.1542/peds.2018-0900 PMID:30131437
Sabbatini AK, Kocher KE, Basu A, Hsia RY. In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department. JAMA. 2016;315(7):663-671. https://doi.org/10.1001/jama.2016.0649 PMID:26881369
Jorgensen S, Zurayk M, Yeung S, et al. Risk factors for early return visits to the emergency department in patients with urinary tract infection. Am J Emerg Med. 2018;36(1):12-17. https://doi.org/10.1016/j.ajem.2017.06.041 PMID:28655424
Lutters M, Vogt-Ferrier NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database Syst Rev. 2008Cd001535. https://doi.org/10.1002/14651858.CD001535
CrossMark reports an erratum (or similar issue). The CrossMark type is "new_version". Additional information can be found at https://doi.org/10.1002/14651858.CD001535.pub2. (Ref. 9 "Lutters, Vogt-Ferrier")
Bader MS, Loeb M, Brooks AA. An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 2017;129(2):242-258. https://doi.org/10.1080/00325481.2017.1246055 PMID:27712137
Kim YJ, Lee JM, Cho J, Lee J. Change in the Annual Antibiotic Susceptibility of Escherichia coli in Community-Onset Urinary Tract Infection between 2008 and 2017 in a Tertiary Care Hospital in Korea. J Korean Med Sci. 2019;34(34):e228. https://doi.org/10.3346/jkms.2019.34.e228 PMID:31456383
- Abstract Viewed: 543 times
- 7372/pdf Downloaded: 335 times