title: Current practice of antibiotic utilization for renal colic in the emergency room.
abstract: BACKGROUND
  Urinalysis (UA) in the emergency setting for patients with nephrolithiasis produces potentially confusing results leading to treatment of presumed urinary tract infections (UTIs). Our objective was to evaluate the use of antibiotics in patients with nephrolithiasis in a large network of emergency departments (EDs).
  
  
  METHODS
  A retrospective analysis of all ED visits associated with an ICD-9 diagnosis of nephrolithiasis and a CT scan between 2010 and 2013 was performed. Urinalysis data, the use of IV and PO antibiotics during the ED visit and at discharge were assessed. The presence of fever, elevated serum WBCs, >5 WBCs per hpf, and/or dip positive nitrites were used as appropriate criteria for antibiotic use.
  
  
  RESULTS
  Urinalysis data were available for 3,518 (70%) of 5,035 patients with an ED diagnosis of nephrolithiasis and CT imaging. Of these visits, 237 patients had positive nitrites (6.7%) and 864 had >5 WBCs per hpf (24.6%) with 158 (4.5%) having both findings for a total of 943 patients. Intravenous antibiotics were given to 244 patients (25.9%) and oral antibiotics were given to 629 patients (66.7 %) with positive UA findings. Of the 2,440 patients with a negative UA and no leukocytosis or fever, 86 patients (3.5%) received IV antibiotics and 533 patients (21.8%) received PO antibiotics upon discharge.
  
  
  CONCLUSIONS
  Proper treatment of nephrolithiasis in the ED includes the screening and diagnosis of concomitant UTIs. However, correct interpretation of UA studies is vital to the correct implementation of antibiotic therapy. This study suggests that 1/3 of patients were undertreated and 21.8% were over-treated.
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Hinck
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Larson
authors.affiliation: Alberta Urology Institute, Edmonton, Alberta, Canada.
authors.forename: Shubha
authors.initials: S
authors.lastname: De
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053040:Nephrolithiasis / Q000188:drug therapy*; D010147:Pain Measurement; D056844:Renal Colic / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic Prophylaxis ; Emergencies; Renal Colic