The lack of association between age and diabetes and hospitalization in women with acute pyelonephritis

Background: Traditional management of acute pyelonephritis (APN) involves hospitalization and intravenous antibiotics. However, recently issued guidelines recommend that women with mild APN can be treated with oral antibiotics. Objectives: Many emergency practitioners feel compelled to admit all elderly and diabetic women with APN to the hospital. We explored the association between age and presence of diabetes with hospital admission in women with APN. Methods: A retrospective chart review was undertaken on women with a diagnosis of APN made in the Emergency Department between May 2003 and December 2005. Exclusion criteria were as follows: pregnancy, immune suppression other than diabetes, urinary stone, septic shock, and hydronephrosis. Standardized chart review was performed and the primary outcome was admission to the hospital. Univariate and multivariate analyses were used to identify factors associated with hospital admission. Results: Of the 388 patients included, 185 (47.7%) were admitted. After adjusting for confounding variables, the odds ratios of admission for those who had been recently hospitalized or had a low serum albumin level or a high C-reactive protein level were 2.10 (95% confidence interval [CI] 1.094.02), 1.96 (95% CI 1.096.05), and 2.57 (95% CI 1.113.46), respectively. Older age and the presence of diabetes were not found to be independently associated with admission. Conclusions: In women with acute pyelonephritis, an older age and diabetes were not found to be independently associated with hospital admission.