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Folly Beach Library
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Edgar Allan Poe/Sullivan's Island Library
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Village Library
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Should emergentologists follow up on patients diagnosed with UTI having negative urine cultures? Implications for processing post‐discharge laboratory results.
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- Author(s): Woodfine, Jason D.; Walraven, Carl
- Source:
Journal of Evaluation in Clinical Practice; Apr2019, Vol. 25 Issue 2, p260-264, 5p, 3 Charts- Subject Terms:
URINARY tract infection diagnosis; URINE microbiology; CONFIDENCE intervals; DATABASES; DRUG resistance in microorganisms; PATIENT aftercare; HOSPITAL emergency services; MEDICAL information storage & retrieval systems; EVALUATION of medical care; MICROBIAL sensitivity tests; RESEARCH funding; URINARY tract infections; URINALYSIS; DISCHARGE planning; RETROSPECTIVE studies; PATIENT readmissions; DESCRIPTIVE statistics; ODDS ratio; EVALUATION - Source:
- Additional Information
- Subject Terms:
- Abstract: Objectives: After patients are discharged from the emergency department (ED), follow‐up of test results focuses on abnormal values. In the elderly, non‐specific symptoms can result in an incorrect diagnosis of urinary tract infection (UTI). This study compared the outcomes of patients discharged from the ED with a diagnosis of UTI based on urine culture results. Methods: We conducted a retrospective cohort study using linked health databases and chart review of a random sample of elderly patients (age > 65 years) discharged from the Ottawa Hospital ED between 2006 and 2014 with a diagnosis of UTI. Patients were categorized based on whether urine cultures were positive and bacterial sensitivity to prescribed antibiotics. Primary outcome was return to ED, admission to hospital, or death within 30 days. Results: A total of 1001 patients were included in the study (401 culture‐negative; 474 culture‐positive antibiotic‐sensitive; 126 culture positive antibiotic‐insensitive). Patients were elderly (mean age 80 years, SD 7.6) with a high prevalence of dementia (18.0%). Almost a third of patients (n = 313, 31.3%) experienced an outcome. Compared to culture‐positive antibiotic‐sensitive patients, culture negative patients (adjOR 1.45, 95% CI 1.07‐1.97) and culture‐positive antibiotic‐insensitive patients (adjOR 1.49, 95% CI 0.90‐2.14) were significantly more likely to experience an outcome (P = 0.04). Conclusions: Patients discharged from the ED with a diagnosis of UTI have an increased risk of return to ED, urgent readmission or death if the uropathogen is insensitive to the prescribed antibiotic or if the culture is negative. Patients diagnosed with UTI with a negative culture may need further assessment. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of Evaluation in Clinical Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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