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

Background: Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisionsmade in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI. Methods: A randomsample of 350 adult ED patientswith UTI by ICD 9/10 codes was selected for review. Relevant datawas extracted frommedical charts and compared between patientswith andwithout EDreturn visitswithin 30 days (ERVs). Results: We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72 h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (P < 0.05) in patientswith the following: age >= 65 years; pregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature >= 38 degrees C heart rate N 100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible). Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P = 0.32). Cephalexin bug-drug mismatchesweremore common in ERV patients (41% vs. 15%; P= 0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; P b 0.05). Conclusions: ERV inUTI patients may beminimized by using ED-source specific antibiogramdata to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up. (C) 2017 Elsevier Inc. All rights reserved.