{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:25:40Z","timestamp":1761218740599,"version":"build-2065373602"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single\u2010centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5\u2010year period (2018\u20132022) was conducted. Eligible cases were identified from ICD\u201010 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>E. coli<\/jats:italic>\n                      <\/jats:styled-content>\n                      , identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1\u20136.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism.\n                      <jats:italic>E. Coli<\/jats:italic>\n                      in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70130","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T08:52:53Z","timestamp":1757580773000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antibiotic Therapy for Pyelonephritis in the Emergency Department"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8068-6752","authenticated-orcid":false,"given":"Jessica","family":"Yu","sequence":"first","affiliation":[{"name":"Emergency and Trauma Centre The Alfred Hospital  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Koolstra","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Centre The Alfred Hospital  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"De Villiers","family":"Smit","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Centre The Alfred Hospital  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-2450","authenticated-orcid":false,"given":"Biswadev","family":"Mitra","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Centre The Alfred Hospital  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"A.Lewington \u201cAcute Pyelonephritis. BMJ Best Practice \u201d(2023) https:\/\/bestpractice.bmj.com\/topics\/en\u2010gb\/3000111."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1702758"},{"volume-title":"Acute Pyelonephritis","year":"2018","author":"Belyayeva M. J. J.","key":"e_1_2_9_4_1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02724-0"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1179\/2047773215Y.0000000030"},{"key":"e_1_2_9_7_1","unstructured":"Therapeutic Guidelines \u201cAcute Pyelonephritis in Adults \u201d(2018) https:\/\/tgldcdp\u2010tg\u2010org\u2010au.ap1.proxy.openathens.net\/viewTopic?etgAccess=true&guidelinePage=Antibiotic&topicfile=acute\u2010pyelonephritis\u2010adults&guidelinename=Antibiotic&sectionId=toc_d1e62#toc_d1e62."},{"key":"e_1_2_9_8_1","unstructured":"Austin Health \u201cSSU Clinical Management Plan: Pyelonephritis Pathway \u201d(Melbourne Austin Health: 2019)."},{"key":"e_1_2_9_9_1","unstructured":"Austin Health \u201cSSU Clinical Management Plan: Medical Review Post Radiology \u201d(Melbourne Austin Health: 2019)."},{"key":"e_1_2_9_10_1","unstructured":"P. H.England \u201cDiagnosis of Urinary Tract Infections: Quick Reference Tool for Primary Care for Consultation and Local Adaptation \u201d(2020) https:\/\/assets.publishing.service.gov.uk\/media\/5f89809ae90e072e18c0ccc2\/UTI_diagnostic_flowchart_NICE\u2010October_2020\u2010FINAL.pdf."},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0164306"},{"issue":"4","key":"e_1_2_9_12_1","first-page":"277","article-title":"The Antibiotic Resistance Crisis: Part 1: Causes and Threats","volume":"40","author":"Ventola C. L.","year":"2015","journal-title":"P and T"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02897-15"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199310283291808"},{"volume-title":"Nosocomial Infections","year":"2024","author":"Sikora A.","key":"e_1_2_9_15_1"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfr810"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlab127"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-019-0492-8"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-066681"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.136"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/10497323231198144"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.70130","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T06:58:55Z","timestamp":1761202735000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.70130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/1742-6723.70130"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.70130","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"type":"print","value":"1742-6731"},{"type":"electronic","value":"1742-6723"}],"subject":[],"published":{"date-parts":[[2025,9,11]]},"assertion":[{"value":"2025-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70130"}}