Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study

Jenny Koehl; Devin Spolsdoff; Briana Negaard; Alison Lewis; Ruben Santiago; James Krenz; Alyssa Polotti; Ryan Feldman; Giles Slocum; David Zimmerman; Gavin T. Howington; Preeyaporn Sarangarm; Alicia E. Mattson; Caitlin Brown; Anne Zepeski; Megan A. Rech; Brett Faine

doi:10.1016/j.annemergmed.2024.10.013

Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study

Jenny Koehl, Devin Spolsdoff, Briana Negaard, Alison Lewis, Ruben Santiago, James Krenz, Alyssa Polotti, Ryan Feldman, Giles Slocum, David Zimmerman, Gavin T. Howington, Preeyaporn Sarangarm, Alicia E. Mattson, Caitlin Brown, Anne Zepeski, Megan A. Rech, Brett Faine

Pharmacy Practice and Science

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Study objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED). Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility. Results: Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval –0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility. Conclusion: Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.

Original language	English
Pages (from-to)	240-248
Number of pages	9
Journal	Annals of Emergency Medicine
Volume	85
Issue number	3
DOIs	https://doi.org/10.1016/j.annemergmed.2024.10.013
State	Published - Mar 2025

Bibliographical note

Publisher Copyright:
© 2024 American College of Emergency Physicians

Funding

Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have declared that no competing interests exist. REDCap database was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537. Author contributions: BF and JK contributed to the study concept and design; BF, JK, CB, AM, AZ, DZ, PS, RS, JK, RF, GS, GH, BN, AK, AP, and AL involved acquisition of data. BF, JK, and DS analyzed and interpreted the data and drafted the manuscript; BF, JK, CB, AM, AZ, DZ, PS, RS, JK, RF, GS, GH, BN, AK, AP, MR, DS and AL performed the critical revision of manuscript for important intellectual content, statistical expertise, and acquisition of funding. BF takes responsibility for the paper as a whole. Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). This research study was supported by a University of Ottawa Department of Emergency Medicine Academic Grant in the amount of $3,390 (#2020-SPF-22). The authors have declared that no competing interests exist. REDCap database was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537.

Funders	Funder number
National Center for Advancing Translational Sciences (NCATS)
National Institutes of Health (NIH)	UL1TR002537
Ottawa University	2020-SPF-22

ASJC Scopus subject areas

Emergency Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.annemergmed.2024.10.013

Cite this

Koehl, J., Spolsdoff, D., Negaard, B., Lewis, A., Santiago, R., Krenz, J., Polotti, A., Feldman, R., Slocum, G., Zimmerman, D., Howington, G. T., Sarangarm, P., Mattson, A. E., Brown, C., Zepeski, A., Rech, M. A., & Faine, B. (2025). Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study. Annals of Emergency Medicine, 85(3), 240-248. https://doi.org/10.1016/j.annemergmed.2024.10.013

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title = "Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study",

abstract = "Study objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED). Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility. Results: Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2\% of cephalosporin vs 22.5\% of fluroquinolone/TMP-SMX group, difference=5.3\%, 95\% confidence interval –0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95\% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility. Conclusion: Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.",

author = "Jenny Koehl and Devin Spolsdoff and Briana Negaard and Alison Lewis and Ruben Santiago and James Krenz and Alyssa Polotti and Ryan Feldman and Giles Slocum and David Zimmerman and Howington, \{Gavin T.\} and Preeyaporn Sarangarm and Mattson, \{Alicia E.\} and Caitlin Brown and Anne Zepeski and Rech, \{Megan A.\} and Brett Faine",

note = "Publisher Copyright: {\textcopyright} 2024 American College of Emergency Physicians",

year = "2025",

month = mar,

doi = "10.1016/j.annemergmed.2024.10.013",

language = "English",

volume = "85",

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Koehl, J, Spolsdoff, D, Negaard, B, Lewis, A, Santiago, R, Krenz, J, Polotti, A, Feldman, R, Slocum, G, Zimmerman, D, Howington, GT, Sarangarm, P, Mattson, AE, Brown, C, Zepeski, A, Rech, MA & Faine, B 2025, 'Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study', Annals of Emergency Medicine, vol. 85, no. 3, pp. 240-248. https://doi.org/10.1016/j.annemergmed.2024.10.013

TY - JOUR

T1 - Cephalosporins for Outpatient Pyelonephritis in the Emergency Department

T2 - COPY-ED Study

AU - Koehl, Jenny

AU - Spolsdoff, Devin

AU - Negaard, Briana

AU - Lewis, Alison

AU - Santiago, Ruben

AU - Krenz, James

AU - Polotti, Alyssa

AU - Feldman, Ryan

AU - Slocum, Giles

AU - Zimmerman, David

AU - Howington, Gavin T.

AU - Sarangarm, Preeyaporn

AU - Mattson, Alicia E.

AU - Brown, Caitlin

AU - Zepeski, Anne

AU - Rech, Megan A.

AU - Faine, Brett

PY - 2025/3

Y1 - 2025/3

N2 - Study objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED). Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility. Results: Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval –0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility. Conclusion: Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.

AB - Study objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED). Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility. Results: Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval –0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility. Conclusion: Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.

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ER -

Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

UN SDGs

Access to Document

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