Association between antibiotic administration before discharge and emergency department length of stay for urinary tract infection: A retrospective analysis.

BACKGROUND: Patients with urinary tract infections (UTIs) may have treatment initiated in the emergency department (ED) before discharge with an antibiotic prescription. The effect of a single antibiotic dose administered prior to discharge on ED length of stay (LOS) is unknown.

OBJECTIVES: The purpose of this study was to compare the LOS and the rate of revisits within 30 days between patients diagnosed with UTIs other than pyelonephritis who received parenteral, oral, or no antibiotic during an ED visit.

METHODS: This was a retrospective cohort study of adult patients with a diagnosis of UTI who received an antibiotic prescription at discharge from a single community ED in the United States between 2019 - 2020. Patients were excluded if they were admitted to the hospital, diagnosed with pyelonephritis, or had an ED visit in the previous 30 days. ED LOS was compared using three-factor ANOVA. ED revisits at 72 hours and 30 days were compared using the Chi-square test.

RESULTS: A total of 694 patients with an ED visit for UTI and an antibiotic prescription at discharge were included. The mean age of the study population was 58 years. Parenteral antibiotic administration in the ED was associated with a 60-minute increase in ED LOS compared to those who received an oral antibiotic (p < 0.001) and a 30-minute increase in ED LOS compared to no antibiotic (p < 0.001). No differences were observed in revisits to the ED at 72 hours (5%, 5%, 2%; p = 0.17) or 30 days (15%, 16%, 17%: p = 0.98) among patients who received parenteral, oral, or no antibiotic before discharge.

CONCLUSIONS: A single dose of parenteral antibiotic prior to discharge was associated with an increased ED LOS compared to treatment with oral antibiotic or discharge without ED treatment. ED revisit rates were similar regardless of ED treatment.