Self-Administered Outpatient Parenteral Antimicrobial Therapy for Urinary Tract Infection from the Emergency Department: A Safe and Effective Strategy to Avoid Hospital Admission

Abstract

Aim: To determine the safety and efficacy of self-administered outpatient parenteral antibiotic treatment (S-OPAT) within a hospitalization-at-home (HaH) program to manage a urinary tract infection (UTI) in patients referred directly from a hospital ED.Materials and Methods: This was a retrospective study of UTI episodes in patients treated initially in the ED, who were subsequently enrolled in a HaH program to receive S-OPAT. Epidemiological, clinical, and microbiological data were recorded. Safety was evaluated by means of mortality and the occurrence of unexpected hospital returns (reason, intra-hospital death) during the domiciliary period. The efficacy was evaluated considering the healing rate and analysis of mortality and repeat hospital admissions because of the UTI recurrence during the first month after discharge.Results: A total of 268 episodes of UTI were analyzed; the mean age of patients was 59.3 years, and 53% were female. The Charlson index was 1.97. The most common types of UTI were acute pyelonephritis and urosepsis. In 61.4% of urine cultures, microbiological documentation was obtained. E. coli was the most commonly isolated microorganism. A total of 27 strains of multidrug resistant microorganisms (MRD) were recorded. The most commonly used antimicrobial drug was ceftriaxone. There was one reported death. Clinical complications that resulted in returning to hospital occurred in 3.4% of cases. The healing rate was 96.5%. During the month after discharge, 4.4% of patients required repeat admission because of the UTI recurrence.Conclusion: S-OPAT within a HaH program in patients with UTI who are referred directly from ED is safe and effective.