Clinical Report: Acute Pyelonephritis Managed in Mayo Clinic's Home-Based Care Program

Overview

This multicenter retrospective cohort study evaluated 165 adults with acute pyelonephritis (AP) managed in the Mayo Clinic's Advanced Care at Home (ACH) program. Despite high illness severity and complex comorbidities, patients were safely treated at home with low escalation rates, short median length of stay, and no in-program mortality.

Background

Acute pyelonephritis is commonly treated outpatient, but 15%–20% of patients require hospitalization due to severity or complications. Hospital stays average 2.8 to 4 days with significant healthcare costs and mortality risk increasing with age and comorbidities. Hospital-at-home (HaH) programs have emerged as alternatives to traditional hospitalization, demonstrating comparable or improved outcomes and patient satisfaction. However, detailed data on AP management in HaH settings in the US remain limited.

Data Highlights

Key Findings

• Patients with AP managed in the ACH program had a median age of 67 years and high comorbidity burden (median CCI of 5).
• Over 90% of patients had moderate to extreme severity of illness and risk of mortality scores.
• Nearly one-third presented with sepsis, and almost half had acute kidney injury; one-third developed bacteremia.
• The median length of stay in the home-based program was 3.1 days, comparable to traditional hospitalization.
• Only 4.8% required escalation to brick-and-mortar hospitals, with no deaths occurring during the program.
• Thirty-day readmission and emergency department visit rates were 17.0% and 4.8%, respectively.

Clinical Implications

The study supports that acute pyelonephritis, even with significant severity and comorbidities, can be effectively and safely managed in a hospital-at-home setting with appropriate patient selection and infrastructure. This model may reduce hospital resource utilization while maintaining low mortality and acceptable readmission rates. Clinicians should consider HaH programs as viable alternatives for suitable AP patients, ensuring rapid escalation protocols are in place.

Conclusion

Mayo Clinic's ACH program demonstrates that hospital-level care for acute pyelonephritis can be delivered safely at home, achieving favorable clinical outcomes and low escalation rates. This approach offers a promising alternative to traditional hospitalization for complex AP cases.

References

1. Mayo Clinic Advanced Care at Home Study 2020-2025 -- Characteristics and Outcomes of AP Patients in HaH