[Acute pyelonephritis treated under "home hospitalization." Ten years' experience].

INTRODUCTION

We present the experience of the Vitoria-Gasteiz Hospital at Home Unit in the treatment of acute pyelonephritis, including an analysis of potential predictors of failure.

PATIENTS AND

METHODS

A total of 369 episodes of acute pyelonephritis without septic shock or renoureteral obstruction are described. After initiating intravenous antibiotic therapy in the hospital emergency department, all patients were referred to the HH. We analyzed the characteristics of the cases and the relationship between several clinical factors and failure of HH care, defined as the need to readmit the patient to conventional hospitalization.

RESULTS

During the study period, 280 women and 89 men (age 16-88 years) met the inclusion criteria. Mean length of HH stay was 5 days and duration of intravenous therapy was 3 days. Sixteen of the 369 cases (4%) had to be readmitted to the hospital because of hypotension, vomiting, pain, fever, or signs of obstruction on ultrasound or because they requested it (four patients). Patients who were readmitted had a higher maximum temperature (mean 39.4 vs. 38.7 degrees C; p = 0.006) than those who remained at the HH. There were no differences between the groups with respect to the other clinical variables studied. The evolution of all 16 hospitalized patients was favorable; only one required a urological intervention.

CONCLUSIONS

Hospital at home care was an effective alternative for managing acute pyelonephritis without shock in 96% of cases referred by the emergency department, and obviated conventional hospital admission, which is usually indicated for this disease.