888. Clinical use of a prediction rule to guide admission policy in community-acquired invasive urinary tract infection: a randomized clinical trial
Session: Poster Abstract Session: Clinical Trials
Friday, October 9, 2015
Room: Poster Hall
  • Poster PRACTICE ID Week 2015.pdf (525.0 kB)
  • Background:  There is a lack of severity assessment tools to help identify adults presenting with febrile urinary tract infection (fUTI) at risk for poor outcome and guide admission policy. We aim to assess the Prediction Rule for Admission policy in Complicated urinary Tract InfeCtion LEiden (PRACTICE) modified from the pneumonia severity index to safely decrease the admission rate of patients with community acquired fUTI.1

    Methods: A multicenter controlled prospective clinical trial with stepped wedge cluster-randomization, from January 2010 to June 2014, at EDs of 7 hospitals in the Netherlands. Follow up period: 84-92 days. Participants: 370 consecutive patients presenting with a presumptive diagnosis of acute pyelonephritis, defined as febrile UTI. Intervention: The intervention provided physicians with the PRACTICE score and corresponding risk class and offered advice on hospitalization policy. In the control period the standard local policy regarding hospital admission applied. Main Outcome: Effectiveness of the clinical prediction score, as measured by primary hospital admission rate, and its safety, as measured by the rate of low-risk patients with PRACTICE-score =< 100 points who needed to be hospitalized for fUTI after initial home-based treatment and 30-day mortality for the total cohort. Trial Registration: NTR4480, www.trialregister.nl

    Results: Of 454 patients screened, a total of 370 patients were included in the trial, 237 in control and 133 in intervention group. Use of the PRACTICE significantly reduced primary hospitalization rate from 92% in the control group to 72% in the intervention group (219/237 vs 96/133; p <0.01). Secondary hospital admission rate was 6% in control patients and 27% in intervention patients (1/18 and 10/37; p<0.001). Four out of these 10 readmitted patients appeared to have a serious condition other than UTI. 30-day mortality was comparable, 2% and 1% respectively.

    Conclusion:  The use of the PRACTICE was associated with a lower number of hospital admissions of patients presenting to the ED with febrile urinary tract infection at the expense of a high secondary admission rate.


      1. v Nieuwkoop C et al. Prospective validation of Prediction Rule for Admission policy in Complicated urinary Tract InfeCtion LEiden (PRACTICE) to predict clinical outcome. Annual Meeting IDSA 2009; Abstract #1057.

    J.E. Stalenhoef, MD1, C. Van Nieuwkoop, MD, PhD2, A.M. Vollaard, MD, PhD1, W.E. Van Der Starre, MD1, N.M. Delfos, MD3, E.M.S. Leyten, MD, PhD4, T. Koster, MD, PhD5, H.C. Ablij, MD6, J.W. Van 't Wout, MD, PhD7 and J.T. Van Dissel, MD, PhD1, (1)Dept of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands, (2)Haga Hospital, The Hague, Netherlands, (3)Alrijne Hospital, Leiderdorp, Netherlands, (4)Medical Center Haaglanden, The Hague, Netherlands, (5)Groene Hart Hospital, Gouda, Netherlands, (6)Diaconessenhuis Leiden, Leiden, Netherlands, (7)Bronovo Hospital, The Hague, Netherlands


    J. E. Stalenhoef, None

    C. Van Nieuwkoop, None

    A. M. Vollaard, None

    W. E. Van Der Starre, None

    N. M. Delfos, None

    E. M. S. Leyten, None

    T. Koster, None

    H. C. Ablij, None

    J. W. Van 't Wout, None

    J. T. Van Dissel, None

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