Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement

doi:10.1093/jac/dkae070

Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement

Pharmacy Practice and Science

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

6 Scopus citations

Abstract

Background: Urinary tract infections (UTIs) are commonly treated in the emergency department (ED), and unfortunately, resistance to first-line agents is increasing. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

Original language	English
Pages (from-to)	1038-1044
Number of pages	7
Journal	Journal of Antimicrobial Chemotherapy
Volume	79
Issue number	5
DOIs	https://doi.org/10.1093/jac/dkae070
State	Published - May 1 2024

Bibliographical note

Publisher Copyright:
© 2024 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site - for further information please contact [email protected].

Funding

We thank: Keith Burrell, University of Iowa; Devin Spolsdoff, MS, University of Iowa; Joann Huynh, PharmD Candidate (2022), University of Illinois at Chicago College of Pharmacy; Kevin Johns, PharmD Candidate (2022), University of Illinois at Chicago College of Pharmacy; Danielle Garza, PharmD; Monica Frauhiger, PharmD; Lyudmila Garbovsky, PharmD, BCPS, BCCCP, Hospital of the University of Pennsylvania, Philadelphia, PA; David Gajdosik, PharmD, BCPS, Hospital of the University of Pennsylvania, Philadelphia, PA; Rachel Lam, Stritch School of Medicine, Loyola University Chicago; and Mollie Shutter, Stritch School of Medicine, Loyola University Chicago. Spero Therapeutics provided an unrestricted research grant via its investigator-initiated research programme. The REDCap database was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537. This study was partially funded by a research grant from the Mayo Midwest Pharmacy Research Committee. Spero Therapeutics provided an unrestricted research grant via its investigator-initiated research programme. The REDCap database was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537. This study was partially funded by a research grant from the Mayo Midwest Pharmacy Research Committee.

Funders	Funder number
Loyola University of Chicago
University of Illinois Hospital & Health Sciences System
Mayo Midwest Pharmacy Research Committee
National Center for Advancing Translational Sciences (NCATS)
Iowa Environmental Mesonet at Iowa State University	2022
National Institutes of Health (NIH)	UL1TR002537

UN SDGs

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

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Pharmacology
Microbiology (medical)
Pharmacology (medical)
Infectious Diseases

Access to Document

10.1093/jac/dkae070

Cite this

@article{3a5904a2d6e0422e91d922179bae4b80,

title = "Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement",

abstract = "Background: Urinary tract infections (UTIs) are commonly treated in the emergency department (ED), and unfortunately, resistance to first-line agents is increasing. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.",

author = "Rech, \{Megan A.\} and Faine, \{Brett A.\} and Gross, \{Alan E.\} and Priyanka Vakkalanka and Brown, \{Caitlin S.\} and Harding, \{Stephanie J.\} and Giles Slocum and David Zimmerman and Anne Zepeski and Stacey Rewitzer and Howington, \{Gavin T.\} and Matt Campbell and Jordan Dawson and Treu, \{Cierra N.\} and Lucas Nelson and Mandy Jones and Tara Flack and Blake Porter and Preeyaporn Sarangarm and Mattson, \{Alicia E.\} and Abby Bailey and Gregory Kelly and Talan, \{David A.\}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site - for further information please contact [email protected].",

year = "2024",

month = may,

day = "1",

doi = "10.1093/jac/dkae070",

language = "English",

volume = "79",

pages = "1038--1044",

number = "5",

}

TY - JOUR

T1 - Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments

T2 - an opportunity for improvement

AU - Rech, Megan A.

AU - Faine, Brett A.

AU - Gross, Alan E.

AU - Vakkalanka, Priyanka

AU - Brown, Caitlin S.

AU - Harding, Stephanie J.

AU - Slocum, Giles

AU - Zimmerman, David

AU - Zepeski, Anne

AU - Rewitzer, Stacey

AU - Howington, Gavin T.

AU - Campbell, Matt

AU - Dawson, Jordan

AU - Treu, Cierra N.

AU - Nelson, Lucas

AU - Jones, Mandy

AU - Flack, Tara

AU - Porter, Blake

AU - Sarangarm, Preeyaporn

AU - Mattson, Alicia E.

AU - Bailey, Abby

AU - Kelly, Gregory

AU - Talan, David A.

N1 - Publisher Copyright: © 2024 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site - for further information please contact [email protected].

PY - 2024/5/1

Y1 - 2024/5/1

N2 - Background: Urinary tract infections (UTIs) are commonly treated in the emergency department (ED), and unfortunately, resistance to first-line agents is increasing. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Background: Urinary tract infections (UTIs) are commonly treated in the emergency department (ED), and unfortunately, resistance to first-line agents is increasing. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

UR - https://www.scopus.com/pages/publications/85192113282

UR - https://www.scopus.com/pages/publications/85192113282#tab=citedBy

U2 - 10.1093/jac/dkae070

DO - 10.1093/jac/dkae070

M3 - Article

C2 - 38482607

AN - SCOPUS:85192113282

SN - 0305-7453

VL - 79

SP - 1038

EP - 1044

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

IS - 5

ER -

Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement

Abstract

Bibliographical note

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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