Risk factors for early return visits to the emergency department in patients with urinary tract infection

Jorgensen, Sarah C J; Zurayk, Mira; Yeung, Samantha; Terry, Jill; Dunn, Maureen; Nieberg, Paul; Wong-Beringer, Annie

doi:10.1016/j.ajem.2017.06.041

Cited by 37 publications

(19 citation statements)

References 22 publications

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“…History of UTI treatment within 14 days before admission has also been previously reported as associated with a UTI-related hospitalization or ED visits [6] and is con rmed by our study. High temperature was reported to be a signi cant factor for UTI related ED return visits in another study [12], and was found in the present study to be associated with a UTI-related hospitalization or ED visits.…”

Section: Discussionsupporting

confidence: 65%

Risk Factors for Urinary Tract Infection (UTI) Among Home Health Care Patients: Analysis Using Routinely Collected Clinical Data

Woo

Song

McDonald

et al. 2020

Preprint

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Abstract Background: Urinary tract infection (UTI) is a complication often experienced during a home health care (HHC) episode, yet related hospitalization risk factors are unclear. Objectives: This study use multiple data sources to identify risk factors for UTI related hospitalization or emergency department (ED) visits among HHC patients.Method: We performed a multivariable logistic regression to identify risk factors for UTI-related hospitalization or ED visits using merged data from the Outcome and Assessment Information Set, electronic health record from a large HHC agency, and Center for Medicare and Medicaid claims. Results: Of 48,336 cases, 1,689 patients (3.5%) had a UTI-related hospitalization/ED visits. Being a female (OR = 1.31; 95% CI: 1.16–1.46), the presence of a urinary catheter (OR = 5.7; 95% CI: 4.54–7.14), treatment with general antibacterial and antiseptics (OR = 2.75; 95% CI: 1.02–7.38), dependency in instrumental activities of daily living (e.g., meal preparation [OR=1.72; 95% CI: 1.25-2.37]), and no available caregivers (OR = 1.79; 95% CI: 1.2–2.68) increased the odds of a UTI related event among HHC patients. Discussion/conclusion: We identified notable risk factors for UTI related hospitalization/ER visit, filling a knowledge gap on the currently understudied HHC population. Risk factors identified in this study can be used to proactively identify HHC patients at risk for UTI related hospitalization and target them for preventive interventions. Further research is needed in HHC to develop tailored interventions for at-risk patients.

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Section: Discussionsupporting

confidence: 65%

Risk Factors for Urinary Tract Infection (UTI) Among Home Health Care Patients: Analysis Using Routinely Collected Clinical Data

Woo

Song

McDonald

et al. 2020

Preprint

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“…For example, unrecognized dementia is associated with diagnostic inaccuracy as clinicians evaluate a patient's acute complaints and the cause of their symptoms . Dementia is also associated with increased use of the ED, prolonged ED length of stay, increased admission rates, prolonged hospitalizations, incident delirium, fall risk, and higher mortality, as well as subsequent ED returns and hospital readmissions . Therefore, older adults with dementia represent a vulnerable ED population that will present with increasing frequency over coming decades.…”

mentioning

confidence: 99%

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Carpenter

Banerjee

Keyes

et al. 2018

Academic Emergency Medicine

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ED-based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT-4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test-treatment threshold calculations.

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“…Pre-implementation review of antimicrobial prescribing and outcomes for patients treated for UTI in the ED revealed substantial opportunity for improvement [ 6 , 12 ]. We therefore assembled a multidisciplinary working group comprised of the ASP team plus ED pharmacists and physicians to develop a best practice UTI empiric antimicrobial treatment algorithm for patients discharged directly from the ED.…”

Section: Methodsmentioning

confidence: 99%

“…We therefore assembled a multidisciplinary working group comprised of the ASP team plus ED pharmacists and physicians to develop a best practice UTI empiric antimicrobial treatment algorithm for patients discharged directly from the ED. Antimicrobial therapy recommendations contained within the algorithm were based upon national and professional society guidelines, primary literature and findings from our background research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection, as reported previously [ 2 , 4 , 6 , 12–27 ]. Several features of our algorithm are noteworthy.…”

Section: Methodsmentioning

confidence: 99%

“…Urinary tract infection (UTI) is a leading cause of infection among patients presented to the ED, accounting for nearly 2 million visits in females of all ages and 160 000 visits in males age 65 years and older in the United States [ 5 ]. Among those discharged with an antibiotic for outpatient treatment, up to 30% required postdischarge interventions primarily due to pathogen nonsusceptibility [ 6 , 7 ]. On the other hand, unnecessary urine collection in asymptomatic patients, poor urine collection technique, and discrepancies in urinalysis interpretations contribute to a large portion of unnecessary antibiotic prescriptions [ 8 ].…”

mentioning

confidence: 99%

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Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

Jorgensen

Yeung

Zurayk

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe complex and fast-paced emergency department (ED) practice setting presents unique challenges that demand a tailored approach to antimicrobial stewardship. In this article, we describe the strategies applied by 1 institution’s antimicrobial stewardship program (ASP) that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED.MethodsCore strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection; collaboration across multiple disciplines; development and implementation of a UTI treatment algorithm; education to increase awareness of the algorithm and the background and rationale supporting it; audit and feedback; and early evaluation of post-implementation outcomes.ResultsWe observed a rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use (P < .05). Our elevation of nitrofurantoin to firstline status was supported by our post-implementation analysis showing that its use was independently associated with reduced 30-day return visits (adjusted odds ratio, 0.547; 95% confidence interval, 0.312–0.960). Furthermore, despite a shift to a higher risk population and a corresponding decrease in antimicrobial susceptibility rates post-implementation, the preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED remained stable.ConclusionsWe demonstrate that an outcomes-based ASP can impart meaningful change to knowledge and attitudes affecting prescribing practices in the ED. The success of our program may be used by other institutions as support for ASP expansion to the ED.

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Risk factors for early return visits to the emergency department in patients with urinary tract infection

Cited by 37 publications

References 22 publications

Risk Factors for Urinary Tract Infection (UTI) Among Home Health Care Patients: Analysis Using Routinely Collected Clinical Data

Risk Factors for Urinary Tract Infection (UTI) Among Home Health Care Patients: Analysis Using Routinely Collected Clinical Data

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

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