Intravenous Antibiotic Susceptibility for Urinary Tract Infection Prior to Emergency Department Discharge

2020 ◽  
pp. 001857872092538
Author(s):  
Stacey Rewitzer ◽  
Josie Montgomery ◽  
Anne Zepeski ◽  
Lexie Finer ◽  
Brett A. Faine
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Antibiotic Use ◽  
Fluoroquinolone Resistance ◽  
Oral Antibiotic ◽  
Antibiotic Regimen ◽  
In Vitro Susceptibility ◽  
Long Acting

Background: Urinary tract infection (UTI) is a common infectious disease managed in the emergency department (ED). Patients may be initially treated with an intravenous (IV) antibiotic and subsequently discharged with an oral antibiotic regimen. Objective: The purpose of this study was to determine whether the current Infectious Diseases Society of America guideline recommendation for an initial dose of long-acting IV antibiotic for treatment of UTI when the prevalence of fluoroquinolone resistance exceeds 10% improves the likelihood of providing in vitro susceptibility to the isolated uropathogen. Methods: This was a retrospective study of patients in ED presenting between May 2009 and August 2018 who received treatment for UTI. The primary outcome was susceptibility of uropathogen to the IV antibiotic administered. Secondary outcomes included susceptibility to the oral antibiotic regimen prescribed at discharge, repeat health care visit within 30 days related to UTI follow-up, adverse events (AEs) associated with antibiotic use, and identification of risk factors associated with pathogen resistance. Results: A total of 255 patients were included for analysis. Of these patients, 230 (90.2%) had pathogens susceptible to the administered IV antibiotic. The oral regimen susceptibility was 81.6% with 29 patients returning for UTI follow-up and 4 patients reporting AEs related to antibiotic use. Men and long-term care facility residents were more likely to have resistant uropathogens. Conclusion: Administration of a long-acting IV antibiotic for treatment of UTI prior to ED discharge is recommended when the fluoroquinolone resistance rate exceeds 10% to improve in vitro susceptibility coverage.

scholarly journals A Mobile Phone Text Message Program to Measure Oral Antibiotic Use and Provide Feedback on Adherence to Patients Discharged From the Emergency Department

2012 ◽  
Vol 19 (8) ◽  
pp. 949-958 ◽  
Author(s):  
Brian Suffoletto ◽  
Jaclyn Calabria ◽  
Anthony Ross ◽  
Clifton Callaway ◽  
Donald M. Yealy
Keyword(s):  
Emergency Department ◽  
Mobile Phone ◽  
Text Message ◽  
Antibiotic Use ◽  
Oral Antibiotic

scholarly journals 131. Duration of Therapy for the Treatment of Gram-Negative Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S94-S95
Author(s):  
Stephanie Shulder ◽  
Matthew O’Connell ◽  
Kaitlyn J Agedal ◽  
Kelly M Conn ◽  
Kelly E Pillinger
Keyword(s):  
Short Duration ◽  
Bloodstream Infections ◽  
Oral Antibiotic ◽  
In Vitro Susceptibility ◽  
Clinical Resolution ◽  
Gram Negative ◽  
Prior Therapy ◽  
Source Of Infection ◽  
Long Duration

Abstract Background While current guidelines suggest a total treatment duration of 7 to 14 days for gram-negative bloodstream infections (GN-BSI), there is mounting evidence to suggest that shorter durations may be sufficient. This study compared the treatment outcomes of patients who received short duration therapy (6–10 days) with those who received long durations (11–15 days). Methods This was a retrospective study of adult patients who grew an aerobic gram-negative organism from a blood culture while admitted at Strong Memorial Hospital between May 2016 and May 2018. The primary outcome was a composite of mortality and relapsed GN-BSI with the same organism within 90 days of index culture. Secondary outcomes included clinical resolution at end of therapy (EOT), length of stay (LOS), 30-day readmission rate, Clostridoides difficile infection (CDI), development of recurrent GN-BSI resistant to prior antibiotic therapy, and development of multi-drug-resistant (MDR) GN-BSI within 90 days. Appropriate therapy was defined as an antibiotic with confirmed in vitro susceptibility that was either parenteral or a highly bioavailable oral antibiotic (fluoroquinolones or sulfamethoxazole–trimethoprim). Results Of 600 patients screened, 116 were included in the long duration group and 34 patients in the short-duration group. The majority of patients had a urinary source of infection (59.3%). The primary composite outcome occurred in 11.8% of the short duration group compared with 10.3% in the long (P > 0.999). There was no difference in clinical resolution at EOT, LOS, or rates of CDI, MDR GN-BSI, recurrent GN-BSI resistant to prior therapy, or 30-day readmission. Patients in the long duration group were discharged with longer appropriate outpatient courses (8 days vs. 0.5 days, P < 0.001), which remained significant when including lower bioavailability agents (e.g., oral β lactams) (8 days vs. 5 days, P < 0.001). Conclusion There was no difference in clinical outcomes between the long and short duration therapy for treatment of GN-BSI. This study may support shorter treatment durations for uncomplicated GN-BSI, but should be interpreted cautiously given the smaller sample size. Disclosures All authors: No reported disclosures.

Alternate Alternatives

2020 ◽  
pp. 241-246
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Low Back Pain ◽  
Back Pain ◽  
Urinary Tract ◽  
Tract Infection ◽  
Emergency Physician ◽  
Elderly Female ◽  
Essentially Normal

In this case, an elderly female presents to the emergency department with a complaint of low back pain for the past few months. She has been receiving treatment from a chiropractor for misalignment of her spine but believes she is not improving. She is seen by an emergency physician, who finds an essentially normal exam. Specifically, she has no neurological findings and a completely normal musculoskeletal exam. Urinalysis shows clear signs of a urinary tract infection. She is started on an antibiotic, and at follow-up her back pain has resolved and her urinalysis is normal. The case provides an opportunity to review complementary and alternative medicine and its pitfalls.

scholarly journals Evaluation of Current Activities of Fluoroquinolones against Gram-Negative Bacilli Using Centralized In Vitro Testing and Electronic Surveillance

2001 ◽  
Vol 45 (1) ◽  
pp. 267-274 ◽  
Author(s):  
Daniel F. Sahm ◽  
Ian A. Critchley ◽  
Laurie J. Kelly ◽  
James A. Karlowsky ◽  
David C. Mayfield ◽  
...  
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
Fluoroquinolone Resistance ◽  
Electronic Surveillance ◽  
Surveillance Network ◽  
In Vitro Susceptibility ◽  
Gram Negative ◽  
Resistance Patterns ◽  
Clinically Significant

ABSTRACT Given the propensity for Enterobacteriaceae and clinically significant nonfermentative gram-negative bacilli to acquire antimicrobial resistance, consistent surveillance of the activities of agents commonly prescribed to treat infections arising from these organisms is imperative. This study determined the activities of two fluoroquinolones, levofloxacin and ciprofloxacin, and seven comparative agents against recent clinical isolates ofEnterobacteriaceae, Pseudomonas aeruginosa,Acinetobacter baumannii, and Stenotrophomonas maltophilia using two surveillance strategies: 1) centralized in vitro susceptibility testing of isolates collected from 27 hospital laboratories across the United States and 2) analysis of data from The Surveillance Network Database-USA, an electronic surveillance network comprising more than 200 laboratories nationwide. Regardless of the surveillance method, Enterobacteriaceae,P. aeruginosa, and A. baumannii demonstrated similar rates of susceptibility to levofloxacin and ciprofloxacin. Susceptibilities to the fluoroquinolones approached or exceeded 90% for all Enterobacteriaceae except Providenciaspp. (≤65%). Approximately 70% of P. aeruginosa and 50% of A. baumanii isolates were susceptible to both fluoroquinolones. Among S. maltophilia isolates, 50% more isolates were susceptible to levofloxacin than to ciprofloxacin. Overall, the rate of ceftazidime nonsusceptibility amongEnterobacteriaceae was 8.7%, with fluoroquinolone resistance rates notably higher among ceftazidime-nonsusceptible isolates than ceftazidime-susceptible ones. Multidrug-resistant isolates were present among all species tested but were most prevalent for Klebsiella pneumoniae andEnterobacter cloacae. No gram-negative isolates resistant only to a fluoroquinolone were encountered, regardless of species. Thus, while levofloxacin and ciprofloxacin have maintained potent activity against Enterobacteriaceae, the potential for fluoroquinolone resistance, the apparent association between fluoroquinolone and cephalosporin resistance, and the presence of multidrug resistance in every species examined emphasize the need to maintain active surveillance of resistance patterns among gram-negative bacilli.

scholarly journals Rural–urban differences in antibiotic prescribing for uncomplicated urinary tract infection

2021 ◽  
pp. 1-8
Author(s):  
Abbye W. Clark ◽  
Michael J. Durkin ◽  
Margaret A. Olsen ◽  
Matthew Keller ◽  
Yinjiao Ma ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Rural Women ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Uncomplicated Urinary Tract Infection ◽  
Urban Status ◽  
To Receive

Abstract Objective: To examine rural–urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). Design: Observational cohort study. Methods: Using the IBM MarketScan Commercial Database (2010–2015), we identified US commercially insured women aged 18–44 years coded for uncomplicated UTI and prescribed an oral antibiotic agent. We classified antibiotic agents and durations as appropriate versus inappropriate based on clinical guidelines. Rural–urban status was defined by residence in a metropolitan statistical area. We used modified Poisson regression to determine the association between rural–urban status and inappropriate antibiotic receipt, accounting for patient- and provider-level characteristics. We used multivariable logistic regression to estimate trends in antibiotic use by rural–urban status. Results: Of 670,450 women with uncomplicated UTI, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Compared to urban women, rural women were more likely to receive prescriptions with inappropriately long durations (adjusted risk ratio 1.10, 95% CI, 1.10–1.10), which was consistent across subgroups. From 2011 to 2015, there was slight decline in the quarterly proportion of patients who received inappropriate agents (48.5% to 43.7%) and durations (78.3% to 73.4%). Rural–urban differences varied over time by agent (duration outcome only), geographic region, and provider specialty. Conclusions: Inappropriate antibiotic prescribing is quite common for the treatment of uncomplicated UTI. Rural women are more likely to receive inappropriately long antibiotic durations. Antimicrobial stewardship interventions are needed to improve outpatient UTI antibiotic prescribing and to reduce unnecessary exposure to antibiotics, particularly in rural settings.

scholarly journals Differences in the Clinical Outcome of Community-Acquired APN According to the Appropriateness of Antibiotic Use

2021 ◽  
Vol 1 (S1) ◽  
pp. s6-s6
Author(s):  
Bongyoung Kim ◽  
Choseok Yoon ◽  
Se Yoon Park ◽  
Ki Tae Kwon ◽  
Seong-yeol Ryu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Use ◽  
Medical Costs ◽  
Clinical Failure ◽  
Medical Problems ◽  
In Vitro Susceptibility ◽  
Susceptibility Tests ◽  
Empirical Antibiotics

Background: The purpose of this study was to find out the relationship between appropriateness of antibiotic prescription and clinical outcomes in patients with community-acquired acute pyelonephritis (CA-APN). Methods: A multicenter prospective cohort study was performed in 8 Korean hospitals from September 2017 to August 2018. All hospitalized patients aged ≥19 years diagnosed with CA-APN at admission were recruited. Pregnant women and patients with insufficient data were excluded. In addition, patients with prolonged hospitalization due to medical problems that were not associated with APN treatment were excluded. The appropriateness of empirical and definitive antibiotics was divided into “optimal,” “suboptimal,” and “inappropriate,” and optimal and suboptimal were regarded as appropriate antibiotic use. The standard for the classification of empirical antibiotics was defined reflecting the Korean national guideline for the antibiotic use in urinary tract infection 2018. The standards for the classification of definitive antibiotics were defined according to the result of in vitro susceptibility tests of causative organisms. Clinical outcomes including clinical failure (mortality or recurrence) rate, hospitalization days, and medical costs were compared between patients who were prescribed antibiotics appropriately and those who were prescribed them inappropriately. Results: In total, 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of these, 10 (2.5%) and 18 (5.7%) were inappropriately prescribed empirical and definitive antibiotics, respectively, and 28 (8.8%) were prescribed either empirical or definitive antibiotics inappropriately. Patients who were prescribed empirical antibiotics appropriately showed a lower mortality rate (0 vs 10%; P = .025), shorter hospitalization days (9 vs 12.5 days; P = .014), and lower medical costs (US$2,333 vs US$4,531; P = .007) compared to those who were prescribed empirical antibiotics “inappropriately.” In comparison, we detected no significant differences in clinical outcomes between patients who were prescribed definitive antibiotics appropriately and those who were prescribed definitive antibiotics inappropriately. Patients who were prescribed both empirical and definitive antibiotics appropriately showed a lower clinical failure rate (0.3 vs 7.1%; P = .021) and shorter hospitalization days (9 vs 10.5 days; P = .041) compared to those who were prescribed either empirical or definitive antibiotics inappropriately. Conclusions: Appropriate use of antibiotics leads patients with CA-APN to better clinical outcomes including fewer hospitalization days and lower medical costs.Funding: NoDisclosures: None

scholarly journals The Great Imitator Strikes Again: Syphilis Presenting as “Tongue Changing Colors”

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Jessica Swanson ◽  
Janna Welch
Keyword(s):  
Emergency Department ◽  
External Genitalia ◽  
Secondary Syphilis ◽  
Chief Complaint ◽  
Rapid Plasma Reagin ◽  
Primary Syphilis ◽  
Long Acting ◽  
Oral Involvement

Syphilis is known as the great imitator, making its diagnosis in the emergency department difficult. A 29-year-old male presented with the chief complaint of “my tongue is changing colors.” A syphilis rapid plasma reagin (RPR) test resulted as positive. In primary syphilis, the chancre is the characteristic lesion. While chancres are frequently found on the external genitalia or anus, extragenital chancres arise in 2% of patients. With oral involvement, the chancre is commonly found on the lip or tongue. The patient was treated for secondary syphilis with 2.4 million units of long acting penicillin intramuscularly. On follow-up a month later, the patient’s symptoms had resolved.

Sign in / Sign up

Export Citation Format

Share Document