ED MANAGEMENT OF ACUTE PYELONEPHRITIS IN WOMEN - A COHORT STUDY

Various treatment strategies are currently used in the management of acute pyelonephritis, with some patients being treated as inpatients and others as outpatients. To better describe the clinical course of patients with this condition and the management strategies of physicians treating these patients, a retrospective cohort study of febrile nonpregnant women presenting to the emergency department with clinical evidence of acute pyelonephritis was conducted. Acute pyelonephritis was defined as infected urine (≥7 white blood cells/high-power field and/or urine culture with ≥104 colony-forming units [CFU]/ml) and fever (≥37.8°C) without other source. Between October 1990 and September 1991, 28 hospitalized and 83 nonhospitalized patients satisfied these criteria. Data were abstracted from hospital charts, and clinical outcomes were determined from chart reviews and telephone or mailed questionnaires. The hospitalized patients were significantly older (odds ratio [OR] = 1.07), had higher temperatures (OR = 6.12), and were more likely to have diabetes (OR = 10.57), genitourinary tract abnormalities (OR = 10.53), and vomiting (OR = 12.17) than the nonhospitalized patients. Sixty-six (80%) of the nonhospitalized patients were treated with a single dose of parenteral antibiotic (usually gentamicin or ceftriaxone) before discharge on oral antibiotics. Seventy-one (86%) were treated with oral trimethoprim-sulfamethoxazole. Follow-up was obtained for 75 (90%) of the nonhospitalized patients. Nine (12%) of the 75 returned because of symptoms of acute pyelonephritis, with 8 returning within 1 day of the initial visit. Seven of those returning were admitted. All responded to additional antibiotic therapy. Selected febrile women with clinical evidence of acute pyelonephritis can be successfully treated as outpatients. In our emergency department (ED), most of these patients received a single dose of parenteral gentamicin or ceftriaxone followed by a course of oral trimethoprim-sulfamethoxazole. Because a significant minority of patients develop worsening symptoms within the first 24 to 36 hours after ED discharge, early follow-up is recommended. © 1994.