Relapsing and recurrent urinary tract infection (UTI) has an economic impact on the healthcare system and can be associated with significant morbidity and mortality. Identification of risk factors for early return visits (ERV) to the emergency department (ED) in patients with UTI can help to mitigate against suboptimal treatment.
A team of investigators from the Department of Pharmacy at Huntington Hospital and the University of Southern California School of Pharmacy conducted a retrospective cohort study to identify risk factors leading to ERV in patients presenting to the ED with a primary or secondary diagnosis of UTI.
A total of 350 patients who were discharged from the ED between July 2015 and June 2016 were selected for inclusion in the study. Early return visit was defined as an ED visit within 30 days of initial presentation. The first ED visit was considered the index visit for patients with multiple returns, and time to ERV was recorded as 72 hours or beyond the index visit.
Urinalysis and urine cultures were performed for diagnostic purposes. Patients were classified as symptomatic based on the presentation of UTI-specific (painful urination, urinary urgency/frequency, etc) or nonspecific (nausea/vomiting, fever, etc) symptoms. Symptomatic patients were then characterized as having a complicated UTI (defined with characteristics such as pregnancy, age ≥65 years, or history of urinary tract abnormalities, among others) or an uncomplicated UTI.
The researchers identified 59 ERVs in 15% of the 350 patients during the study period; 47% of the ERVS were related to the UTI, 6% of patients returned to the ED within 72 hours, and 2% of patients had 2 ERVs.
Patients with ERVs were significantly older compared with those who did not return to the ED. Nearly half of ERV patients were ≥65 years of age (45% vs 27%; P =.008). Other risk factors for ERV included pregnancy (odds ratio [OR] 6.3; 95% CI, 1.8-22.0; P =.02), healthcare exposure within 6 months of the index ED visit (OR, 2.3; 95% CI, 1.2-4.1; P =.01), and psychiatric disorder (OR, 2.2; 95% CI, 1.1-4.5; P =.03).
Results, separated into 2 groups of patients with and without ERVs, further showed that approximately half of the patients with ERVs received parenteral antibiotics while in the ED (59% vs 48%; P =.15) with ceftriaxone prescribed in almost all instances (97% vs 94%; P >.99).
The researchers concluded that outpatient follow-up is important in examining risk factors for ERVs. “Simple clinical parameters such as fever and tachycardia can enable detection of at risk individuals who may be targeted for close follow-up after discharge from the ED and for prompt intervention if needed.”
Jorgensen S, Zurayk M, Yeung S, et al. Risk factors for early return visits to the emergency department in patients with urinary tract infection [published online June 21, 2017]. Am J Emerg Med. doi: 10.1016/j.ajem.2017.06.041