Follow-up of patients with urinary tract infections discharged from the emergency department: a mixed methods study.
J Antimicrob Chemother
; 79(7): 1688-1696, 2024 Jul 01.
Article
de En
| MEDLINE
| ID: mdl-38819815
ABSTRACT
OBJECTIVES:
To evaluate the quality of culture follow-up after emergency department (ED) discharge in patients with urinary tract infections (UTIs).METHODS:
This convergent mixed methods study included an observational cohort study and a qualitative interview study in UTI patients discharged from the ED of a Dutch university hospital. The primary outcomes of the observational study were the proportion of patients requiring adjustment of antibiotic therapy after culture review, and the proportion of patients in whom these adjustments were made. Logistic regression identified factors associated with these outcomes. Interviews assessed patient experiences and transcripts were analysed using inductive thematic content analysis. Integration of the results informed recommendations for high-quality follow-up.RESULTS:
Out of 455 patients, 285 (63%) required culture-based treatment adjustments. In most patients, no adjustments were made (239/285, 84%). De-escalation was most frequently omitted (98%), followed by discontinuation of antibiotics (92%). A mean of 7.1 (SDâ 3.8) antibiotic days per patient could have been avoided in 103 patients. Patients with diabetes were less likely to require adjustments (aORâ â0.50, 95%-CIâ 0.29-0.85). Patients with moderate or severe renal impairment (aORâ 4.1, 95%-CIâ 1.45-11.33; aORâ 4.2, 95%-CIâ â1.50-11.94) or recurrent UTIs (aORâ 5.0, 95%-CIâ 2.27-11.18) were more likely to have received necessary adjustments. Twelve interviews also revealed varying degrees of follow-up. Three themes were identified 'information and communication', 'coordination and accessibility of care' and 'individual needs and preferences'. Recommendations for high-quality follow-up advocate a person centred approach.CONCLUSIONS:
This study highlights the importance of urine culture follow-up after ED discharge, mainly to reduce unnecessary antibiotic treatment, promote de-escalation and improve patient experience.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Sortie du patient
/
Infections urinaires
/
Service hospitalier d'urgences
/
Antibactériens
Limites:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Pays/Région comme sujet:
Europa
Langue:
En
Journal:
J Antimicrob Chemother
Année:
2024
Type de document:
Article
Pays d'affiliation:
Pays-Bas