Outcome in acute uncomplicated pyelonephritis after discharge home following initial hospital emergency department treatment

Lluís M, Miró O, Perea Molera M, Pedrol E, Mijana M, Rodellar MT, Torrents A

Objective: To determine the clinical course and safety of patients discharged home after

hospital emergency department treatment of acute uncomplicated pyelonephritis.

Methods: This prospective, longitudinal, noninterventional, multicenter study enrolled

women diagnosed with acute uncomplicated pyelonephritis at 2 hospital emergency

services. No patient stayed in the emergency room longer than 24 hours. Medical

history, current complaints, test results, and prescribed treatment were recorded for all

patients. Between 3 to 5 days after discharge the patient was telephoned to assess

clinical course (resolution of fever, lower back pain, and urinary tract symptoms). If

symptoms persisted, the patient was called again between 7 and 10 days after

discharge. The caller asked if the patient had consulted another doctor and if that

consultation led to changes in treatment and/or hospitalization was required.

Results: Seventy-one patients were enrolled; 83% experienced complete resolution

within 10 days of discharge. The survival curves of cures were practically identical for the

2 emergency services (no significant difference). Lower back pain was the symptom that

took the longest to resolve (P<.01, with respect to both fever and urinary tract symptoms). Twelve patients (16.9%) consulted a doctor again and only 2 (2.8% of the entire cohort) had to be hospitalized. Although certain factors were associated with longer duration of certain symptoms, no particular factor was found to correlate with early resolution. Conclusions: Most patients diagnosed with acute pyelonephritis are cured without requiring hospitalization. Discharge home from the emergency department is therefore justified after an observation period in which a first parenteral antibiotic dose is administered and an appropriate oral antibiotic is chosen. The patient should be warned of the possibility of the persistence of some symptoms and referred for appropriate outpatient follow-up.

Lluís M, Mijana M, Miró O, Pedrol E, Perea Molera M, Rodellar MT, Torrents A