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Hospital admission patterns of adult patients with complicated urinary tract infections who present to the hospital by disease acuity and comorbid conditions: How many admissions are potentially avoidable?

      Highlights

      • Hospital admissions for complicated urinary tract infections (cUTI) are rising.
      • There is scant information on the clinical acuity of hospitalized cUTI patients.
      • This study describes the characteristics of hospitalized cUTI patients in the United States.
      • Approximately 1 in 5 cUTI admissions occurred in patients with low acuity and may be avoidable.
      • Results highlight need to develop well-defined criteria for cUTI admissions.

      Background

      Hospital admissions for complicated urinary tract infections (cUTI) in the United States are increasing but there are limited information on the acuity of patients who are admitted.

      Objective

      Describe hospitalization patterns among adult cUTI patients who present to the hospital with cUTI and to determine the proportion of admissions that were of low acuity.

      Methods

      A retrospective multi-center analysis using data from the Premier Healthcare Database (2013-2018) was performed. Inclusion criteria: age ≥ 18 years, cUTI diagnosis, positive blood or urine culture. Hospital admissions were stratified by presence of sepsis, systemic symptoms but no sepsis, and Charlson Comorbidity Index (CCI).

      Results

      187,789 patients met the inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 systemic symptom (but no sepsis), and 53.9% had no sepsis or systemic symptoms. The median [inter-quartile range] CCI was 1 [0, 3]. Sixty-four percent of patients were admitted to hospital, and 18.9% of admissions occurred in patients with low acuity (no sepsis or systemic symptoms and a CCI ≤ 2). The median [IQR] LOS and costs for low acuity inpatients who were admitted were 3 [2, 5] days and $5,575 [$3,607, $9,133], respectively.

      Conclusion

      Nearly 1 in 5 cUTI hospital admissions occurred in patients with low acuity, and therefore may be avoidable.

      Graphical abstract

      Key words

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      References

        • Hardin L
        • Mason DJ
        Bringing it home: the shift in where health care is delivered.
        Jama. 2019; 322: 493-494
        • Sabih A
        • Leslie SW
        Complicated urinary tract infections.
        ([Updated 2021 Feb 10])StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)2021 (Available at:)
        • Carreno JJ
        • Tam IM
        • Meyers JL
        • Esterberg E
        • Candrilli SD
        • Lodise Jr, TP
        Longitudinal, Nationwide, Cohort Study to Assess Incidence, Outcomes, and Costs Associated With Complicated Urinary Tract Infection.
        Open forum infectious dis. 2019; 6
        • Healthcare Cost and Utilization Project
        Emergency Department Visits—159 Urinary Tract Infections. CCS [Internet].
        Agency for Healthcare Research and Quality, 2014 (Available at:)
        • Burwell SM
        Setting value-based payment goals–HHS efforts to improve U.S. health care.
        N Engl J Med. 2015; 372: 897-899
        • Simmering JE
        • Tang F
        • Cavanaugh JE
        • Polgreen LA
        • Polgreen PM
        The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998-2011.
        Open forum infectious dis. 2017; 4: ofw281
        • Turner RM
        • Wu B
        • Lawrence K
        • Hackett J
        • Karve S
        • Tunceli O
        Assessment of outpatient and inpatient antibiotic treatment patterns and health care costs of patients with complicated urinary tract infections.
        Clin therapeutics. 2015; 37: 2037-2047
      1. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb259-Potentially-Preventable-Hospitalizations-2017.pdf. Accessed April 1, 2021.

      2. https://products.premierinc.com/downloads/PremierHealthcareDatabaseWhitepaper.pdf. Accessed April 1, 2021.

        • Deyo RA
        • Cherkin DC
        • Ciol MA
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Dellinger RP
        • Levy MM
        • Carlet JM
        • et al.
        Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.
        Critical care med. 2008; 36: 296-327
        • Iwashyna TJ
        • Odden A
        • Rohde J
        • et al.
        Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis.
        Med Care. 2014; 52: e39-e43
        • Jolley RJ
        • Quan H
        • Jette N
        • et al.
        Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data.
        BMJ Open. 2015; 5e009487
        • Jolley RJ
        • Sawka KJ
        • Yergens DW
        • Quan H
        • Jette N
        • Doig CJ
        Validity of administrative data in recording sepsis: a systematic review.
        Crit care (London, England). 2015; 19: 139
        • Lodise TP
        • Izmailyan S
        • Olesky M
        • Lawrence K
        An evaluation of treatment patterns and associated outcomes among adult hospitalized patients with lower-risk community-acquired complicated intra-abdominal infections: how often are expert guidelines followed?.
        Open forum infectious diseases. 2020; 7: ofaa237
        • Klahr S
        • Miller SB
        Acute oliguria.
        N Engl J Med. 1998; 338: 671-675
        • Schrock JW
        • Reznikova S
        • Weller S
        The effect of an observation unit on the rate of ED admission and discharge for pyelonephritis.
        Am J Emerg Med. 2010; 28: 682-688
        • Kim K
        • Lee CC
        • Rhee JE
        • et al.
        The effects of an institutional care map on the admission rates and medical costs in women with acute pyelonephritis.
        Acad Emerg Med. 2008; 15: 319-323
        • Elkharrat D
        • Chastang C
        • Boudiaf M
        • Le Corre A
        • Raskine L
        • Caulin C
        Relevance in the emergency department of a decisional algorithm for outpatient care of women with acute pyelonephritis.
        Eur J Emerg Med. 1999; 6: 15-20
        • Ward G
        • Jorden RC
        • Severance HW
        Treatment of pyelonephritis in an observation unit.
        Ann Emerg Med. 1991; 20: 258-261
        • Fine MJ
        • Auble TE
        • Yealy DM
        • et al.
        A prediction rule to identify low-risk patients with community-acquired pneumonia.
        N Engl J Med. 1997; 336: 243-250
        • Fine MJ
        • Hough LJ
        • Medsger AR
        • et al.
        The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study.
        Arch Intern Med. 1997; 157: 36-44
        • Critchley IA
        • Cotroneo N
        • Pucci MJ
        • Mendes R
        The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017.
        PLoS One. 2019; 14e0220265
        • Rank EL
        • Lodise T
        • Avery L
        • et al.
        Antimicrobial susceptibility trends observed in urinary pathogens obtained from New York State.
        Open forum infectious dis. 2018; 5: ofy297
        • Sanchez GV
        • Babiker A
        • Master RN
        • Luu T
        • Mathur A
        • Bordon J
        Antibiotic resistance among urinary isolates from female outpatients in the United States in 2003 and 2012.
        Antimicrobial agents and chemotherapy. 2016; 60: 2680-2683
        • Mogle BT
        • Beccari MV
        • Steele JM
        • Fazili T
        • Kufel WD
        Clinical considerations for oral beta-lactams as step-down therapy for Enterobacteriaceae bloodstream infections.
        Expert Opin Pharmacother. 2019; 20: 903-907
        • Gupta K
        • Hooton TM
        • Naber KG
        • et al.
        International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
        Clin infectious dis: an off public of the Infectious Dis Soc Am. 2011; 52: e103-e120
        • Randolph TC
        • Parker A
        • Meyer L
        • Zeina R
        Effect of a pharmacist-managed culture review process on antimicrobial therapy in an emergency department.
        Am J Health Syst Pharm. 2011; 68: 916-919
        • Davis LC
        • Covey RB
        • Weston JS
        • Hu BB
        • Laine GA
        Pharmacist-driven antimicrobial optimization in the emergency department.
        Am J Health Syst Pharm. 2016; 73: S49-S56
        • Dumkow LE
        • Beuschel TS
        • Brandt KL
        Expanding Antimicrobial stewardship to urgent care centers through a pharmacist-led culture follow-up program.
        Infect Dis Ther. 2017; 6: 453-459
        • Jorgensen S
        • Zurayk M
        • Yeung S
        • et al.
        Risk factors for early return visits to the emergency department in patients with urinary tract infection.
        Am J Emerg Med. 2018; 36: 12-17
        • Durojaiye OC
        • Kritsotakis EI
        • Johnston P
        • Kenny T
        • Ntziora F
        • Cartwright K
        Developing a risk prediction model for 30-day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy.
        Clin Microbiol Infect. 2019; 25 (905 e901-905 e907)
        • Underwood J
        • Marks M
        • Collins S
        • Logan S
        • Pollara G
        Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy.
        J Antimicrob Chemother. 2019; 74: 787-790
        • Hale CM
        • Steele JM
        • Seabury RW
        • Miller CD
        Characterization of drug-related problems occurring in patients receiving outpatient antimicrobial therapy.
        J Pharm Pract. 2017; 30: 600-605
        • Means L
        • Bleasdale S
        • Sikka M
        • Gross AE
        Predictors of hospital readmission in patients receiving outpatient parenteral antimicrobial therapy.
        Pharmacotherapy. 2016; 36: 934-939
        • Allison GM
        • Muldoon EG
        • Kent DM
        • et al.
        Prediction model for 30-day hospital readmissions among patients discharged receiving outpatient parenteral antibiotic therapy.
        Clin Infect Dis. 2014; 58: 812-819
        • Jain A
        • Utley L
        • Parr TR
        • Zabawa T
        • Pucci MJ
        Tebipenem, the first oral carbapenem antibiotic.
        Expert Rev Anti Infect Ther. 2018; 16: 513-522
      3. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing. Accessed April 1, 2021.

      4. https://www.aapc.com/blog/31689-sepsis-and-sirs-in-icd-10-cm/. Accessed April 1, 2021.