Adherence to evidence-based guidelines for the management of pyelonephritis in pregnancy

Abstract

Pyelonephritis occurs in approximately two per cent of pregnancies and can cause significant maternal and fetal morbidity and mortality. Evidence-based guidelines recommend appropriate antibiotic therapy, urine culture for test of cure after treatment and monthly follow-up cultures until delivery. To evaluate adherence to guidelines for the management of antepartum pyelonephritis within an Australian obstetric population and to assess associations with noncompliance. A retrospective study was performed for the 103 pregnant women admitted with pyelonephritis between January 2001 and December 2009 at the Royal Brisbane and Women's Hospital, a tertiary referral obstetric hospital. We assessed baseline characteristics, the frequency of appropriate treatment and follow-up, and any associations among these. The guideline recommended antibiotic treatment was prescribed in 90.3% of women. Of the women with antibiotic-resistant organisms, 31.6% had their antibiotics changed appropriately. The test of cure urine culture was performed in only 35.0% of women after treatment completion. Inadequate long-term follow-up occurred in 60.2% of the cohort studied. Inappropriate follow-up was associated with low socioeconomic status (P=0.04), unemployment (P=0.04) and the absence of a test of cure urine culture (P=0.001). The empiric treatment of antepartum pyelonephritis is generally appropriate; however, antibiotic changes for bacterial resistance are inadequate. Test of cure and monthly follow-up urine cultures are infrequently performed despite their recommendation in published treatment guidelines.