Annals of emergency medicine · 2026
DO Generations MAtter for Treatment of Outpatient Pyelonephritis With Cephalosporins in the Emergency Department? DOGMA-ED Study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Mattson Alicia E, Spolsdoff Devin, Brown Caitlin S, Fletcher Ana Avram, Laehn Spencer, Ray Lance, Polotti Alyssa B, Feldman Ryan, Slocum Giles W, Santiago Ruben, Krenz James, Zimmerman David E, Woolum Jordan A, Howington Gavin T, Sarangarm Preeyaporn, Zepeski Anne, Negaard Briana, Lewis Alison, Koehl Jenny, Rech Megan A, Talan David, Faine Brett
Аннотация
STUDY OBJECTIVE: The primary objective of this study was to compare the effectiveness between first-, second-, and third-generation oral cephalosporins for the treatment of pyelonephritis in adult patients discharged from the emergency department (ED).
METHODS: This was a multicenter, retrospective, observational cohort study of 11 geographically distributed academic US EDs. Patients aged ≥18 years who were diagnosed with pyelonephritis and discharged home on an oral cephalosporin from the ED between August 1, 2023 and January 1, 2025 were included. The primary outcome was treatment failure at 14 days between the cephalosporin generations. The composite outcome was defined as one of the following: (1) recurrence of symptoms, (2) repeat ED/urgent care visit due to urinary tract infection, (3) receipt of a new antibiotic prescription for urinary symptoms, or (4) hospitalization due to urinary tract infection. Secondary outcomes included the need to modify the patient's initial antimicrobial regimen based on culture and susceptibility.
RESULTS: A total of 1,147 patients met inclusion, with 618 (53.9%) receiving a first-generation, 91 (7.9%) a second-generation, and 438 (38.2%) a third-generation cephalosporin. Baseline characteristics were similar across cohorts, with women comprising over 85% of the study population. The most prescribed agents were cephalexin (85% of first generation), cefuroxime (100% of second generation), and cefdinir (79% of third generation). There was no statistically significant difference in 14-day treatment failure rates across generations (first versus second: 19.6% versus 17.6%, difference 2.0%, 95% confidence interval (CI) -7.1 to 11.1; first versus third: 19.6% versus 18.0%, difference 1.6%, 95% CI -3.4 to 6.5).
CONCLUSION: First-, second-, and third-generation oral cephalosporins demonstrated comparable 14-day treatment failure rates for the treatment of acute pyelonephritis in patients discharged from the ED.
METHODS: This was a multicenter, retrospective, observational cohort study of 11 geographically distributed academic US EDs. Patients aged ≥18 years who were diagnosed with pyelonephritis and discharged home on an oral cephalosporin from the ED between August 1, 2023 and January 1, 2025 were included. The primary outcome was treatment failure at 14 days between the cephalosporin generations. The composite outcome was defined as one of the following: (1) recurrence of symptoms, (2) repeat ED/urgent care visit due to urinary tract infection, (3) receipt of a new antibiotic prescription for urinary symptoms, or (4) hospitalization due to urinary tract infection. Secondary outcomes included the need to modify the patient's initial antimicrobial regimen based on culture and susceptibility.
RESULTS: A total of 1,147 patients met inclusion, with 618 (53.9%) receiving a first-generation, 91 (7.9%) a second-generation, and 438 (38.2%) a third-generation cephalosporin. Baseline characteristics were similar across cohorts, with women comprising over 85% of the study population. The most prescribed agents were cephalexin (85% of first generation), cefuroxime (100% of second generation), and cefdinir (79% of third generation). There was no statistically significant difference in 14-day treatment failure rates across generations (first versus second: 19.6% versus 17.6%, difference 2.0%, 95% confidence interval (CI) -7.1 to 11.1; first versus third: 19.6% versus 18.0%, difference 1.6%, 95% CI -3.4 to 6.5).
CONCLUSION: First-, second-, and third-generation oral cephalosporins demonstrated comparable 14-day treatment failure rates for the treatment of acute pyelonephritis in patients discharged from the ED.