Epidemiological profile and management of acute pyelonephritis in the emergency department of a tertiary hospital: A retrospective observational study

Abstract

Objective: To assess the clinical and microbiological characteristics as well as the risk factors of early readmission (<72 h) in acute pyelonephritis (APN) patients discharged from emergency department (ED). Methods: The medical records of patients discharged with a diagnosis of APN between January 1, 2014 and December 31, 2015 were reviewed. Epidemiological, clinical, ultrasound results, and laboratory characteristics were collected, and the risk factors of prompt readmission and non-prompt readmission were assessed. Results: A total of 423 APN patients were included. The mean age was (44.3±19.0) years. The bulk of the patients were women (79.9%), and 20% of cases had episodes previously. Urine cultures were requested in 77.5% of cases, with Escherichia coli being the most frequently isolated bacterium (80.1%). Resistance to one or more antibiotics was found in 68.1% of the bacteria. The most widely used antibiotics were beta-lactam with beta-lactamases inhibitor (46%), and aminoglycosides in 24.4% of cases. Altogether, 73.5% of the patients received antibiotic treatment in the ED, and 46.8% of the patients were discharged. Furthermore, 6.1% of the patients discharged from the ED had re-admission without associated risk factors. Conclusions: Given the high rate of resistance, it is important to know the profile of antibiotics in different areas. Likewise, the administration of antibiotics in the ED is useful in the prevention of early readmissions of APN (<72 h).

Keywords

• acute pyelonephritis; emergencies; resistances; antibiotics; re-admission