MP26-07 USE OF ANTIBIOTICS IN MANAGEMENT OF UPPER URINARY TRACT STONES IN THE EMERGENCY DEPARTMENT

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2016MP26-07 USE OF ANTIBIOTICS IN MANAGEMENT OF UPPER URINARY TRACT STONES IN THE EMERGENCY DEPARTMENT Amanda C Chi, Christopher D Morrison, Aziz Khambati, and Robert B Nadler Amanda C ChiAmanda C Chi More articles by this author , Christopher D MorrisonChristopher D Morrison More articles by this author , Aziz KhambatiAziz Khambati More articles by this author , and Robert B NadlerRobert B Nadler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urolithiasis is a common reason for emergency department (ED) visits, with a prevalence of 8.8% in the United States. ED practitioners are confronted with identifying patients who are at risk for infectious complications. Our objective is to understand the use of antibiotics and laboratory tests by the ED in management of upper urinary tract stones. METHODS We conducted an IRB approved retrospective review of patients who presented to Northwestern Hospital system from 2009 to 2014 with symptomatic stones and a primary diagnosis of urolithiasis, using ICD-9 codes. Only patients who had CT-confirmed upper urinary tract urolithiasis were included. RESULTS 3247 encounters were identified, accounting for 1385 female and 1860 male patients with mean age of 47 years. 2093 (64%) encounters had urine cultures sent from ED, of which 203 (6%) were positive. 486 (15%) patients received antibiotics in the ED alone. 168 (5%) patients received antibiotics upon discharge but not in the ED. 190 (6%) patients received antibiotics both in the ED and upon discharge. Twenty percent of those who received antibiotics had positive urine cultures. Sixteen percent of patients who received antibiotics did not have cultures drawn while in the ED. Overall, 51% of patients with positive urine cultures were treated and 19% of patients with positive urine culture were not on antibiotics on discharge. Culture results of patients in each group are shown in Table 1. CONCLUSIONS The rate of infection in patients presenting to ED with symptomatic urolithiaisis was low, at 6%. Twenty-six percent of patients received antibiotic therapy in the ED and/or upon discharge. Of these patients, 80% ultimately did not have a positive urine culture. However, only 51% of patients with positive cultures were treated. Furthermore, urine cultures are not consistently obtained for all patients, even in those who were thought to warrant antibiotics. Protocol for management of urolithiasis and associated infections in the ED should be developed to standardize and streamline the care of these patients and minimize antibiotic overuse. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e356 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Amanda C Chi More articles by this author Christopher D Morrison More articles by this author Aziz Khambati More articles by this author Robert B Nadler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...