To evaluate the characteristics and clinical outcomes of patients with acute pyelonephritis treated in a hospital-at-home setting, highlighting the significance of this approach in improving patient care.
Key Findings:
165 patients included, median age 67 years.
Severity of illness scores: moderate (33.3%), major (52.1%), extreme (8.5%).
Charlson Comorbidity Index median score was 5; all patients had preexisting genitourinary conditions.
30.9% met sepsis criteria, 47.3% had acute kidney injury, and 33.3% developed bacteremia.
Median length of stay was 3.1 days; only 4.8% required escalation to a hospital.
Readmission rate was 17.0%, and 4.8% had emergency department visits; no in-program deaths occurred.
Interpretation:
Acute pyelonephritis can be managed safely and effectively in a hospital-at-home setting, even in patients with high illness severity and complex comorbidities, with appropriate patient selection and infrastructure, suggesting a need for further research in this area.
Limitations:
Retrospective study design may introduce selection bias and limit causality.
Findings may not be generalizable to all hospital-at-home programs.
Conclusion:
The study supports the feasibility of managing acute pyelonephritis in a home-based care setting, emphasizing the importance of robust support systems and careful patient selection for safety.
by Cesar A Gomez-Cabello, Igor Dumic, Michael J Maniaci, Margaret R Paulson, Aryan Shiari, Leah W Webster, Jeni McGrew, Ariana Genovese, Bernardo Collaco, Maissa Trabilsy, Antonio J Forte, Wendelyn Bosch
