490: GBS Urinary Tract Infections: Is the risk of pyelonephritis as high as with E. Coli?

Abstract

GBS colonization of the lower urinary tract in pregnancy is associated with severe infections such as chorioamnionitis, endometritis, and pyelonephritis. We sought to explore pregnancy morbidity secondary to lower urinary tract colonization or infection with GBS as compared to E. coli, a more common urinary pathogen. Retrospective cohort of pregnant women with lower urinary tract infections (asymptomatic bacteria (ASB) or urinary tract infection (UTI)) from a single academic center from 7/2013-5/2019. Demographic, infectious, antepartum, and intrapartum data were abstracted from women with either GBS or E. coli ASB or UTI. The primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, pyelonephritis length of stay (LOS), preterm delivery (PTD), and low birth weight (LBW). Logistic regression was used to calculate the adjusted odds of the primary outcome. Of 378 pregnant women with urinary colonization, 116 (30.7%) had GBS and 166 (43.9%) had E. coli. Women with E. coli were younger and more likely to have a history of UTI or prior preterm birth than women with GBS (Table 1). Rates of progression to pyelonephritis were markedly higher with E. coli (30.7%) than with GBS (3.5%; p < .001). Median LOS for pyelonephritis and pyelonephritis morbidities did not differ. Median gestational age (GA) at delivery, PTD, and LBW rates also did not differ (Table 2). When controlling for history of UTI, history of pyelonephritis, baseline hematocrit, prior preterm birth, and maternal age, women with GBS had 87% lower odds (aOR 0.13, 95% CI 0.05-0.40) of developing pyelonephritis in pregnancy compared to those with E. coli. E. coli infections progress to pyelonephritis in pregnancy at markedly higher rates than GBS, although obstetric outcomes are similar.View Large Image Figure ViewerDownload Hi-res image Download (PPT)