Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study.

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine Pub Date : 2024-11-19 DOI:10.1016/j.annemergmed.2024.10.013

Jenny Koehl, Devin Spolsdoff, Briana Negaard, Alison Lewis, Ruben Santiago, James Krenz, Alyssa Polotti, Ryan Feldman, Giles Slocum, David Zimmerman, Gavin T Howington, Preeyaporn Sarangarm, Alicia E Mattson, Caitlin Brown, Anne Zepeski, Megan A Rech, Brett Faine

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引用次数: 0

Abstract

Study objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED).

Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility.

Results: Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval -0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility.

Conclusion: Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.

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急诊科门诊患者肾盂肾炎的头孢菌素治疗：COPY-ED 研究。

研究目的我们研究的主要目的是比较口服头孢菌素与氟喹诺酮类药物和三甲氧苄青霉素/磺胺甲恶唑（TMP-SMX）治疗急诊科（ED）出院回家患者肾盂肾炎的效果：这是一项多中心、回顾性、观察性队列研究，涉及美国 11 个不同地区的急诊科。研究纳入了 2021 年 1 月 1 日至 2023 年 10 月 31 日期间确诊为肾盂肾炎并从急诊科出院回家的年龄≥18 岁的患者。主要结果是 14 天后的治疗失败，定义为以下情况的综合结果：(1) 再次出现尿路症状；(2) 因尿路感染再次到急诊室就诊或住院；(3) 因尿路感染收到新的抗生素处方。次要结果是根据尿液培养敏感性进行经验性治疗的适当性：在符合纳入标准的 851 名患者中，647 名患者接受了头孢菌素治疗，204 名患者接受了美国传染病学会指南认可的一线治疗（氟喹诺酮类、TMP-SMX）。总体而言，两组患者的基线特征相似。头孢菌素组与氟喹诺酮/TMP-SMX组的治疗失败率无明显差异（头孢菌素组17.2% vs 氟喹诺酮/TMP-SMX组22.5%，差异=5.3%，95%置信区间-0.118~0.01）。调整潜在混杂因素后，头孢菌素的使用与治疗失败无关（几率比=0.22，95% 置信区间为 0.03 至 1.95）。根据尿培养药敏性进行适当经验性治疗的比率没有差异：结论：在治疗出院回家的急诊科患者肾盂肾炎时，口服头孢菌素与美国传染病学会指南推荐的治疗方法相比，治疗失败率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of emergency medicine 医学-急救医学

CiteScore

8.30

自引率

4.80%

发文量

819

审稿时长

20 days

期刊介绍： Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics.