Adverse Pregnancy Outcomes Among Women With Urinary Tract Infections: Comparing Sensitive and Resistant Organisms [27C

Abstract

INTRODUCTION: The primary aim of this study was to examine whether uropathogen resistance affects the rate of preterm birth. Second, to examine whether uropathogen resistance affects the rate of perinatal maternal or neonatal infectious morbidity. METHODS: Retrospective cohort study of pregnant women who (1) received obstetric care and delivered at Stanford Children’s Hospital/Lucile Packard Children’s Hospital on the university teaching service and (2) had at least one positive urine culture (≥ 100,000 colony-forming units (cfu) per milliliter (mL)) performed through the Microbiology Lab between January 1, 2010 and August 31, 2014. Urine cultures that yielded likely contaminants were excluded from our analysis. We categorized organisms as “sensitive” or “resistant” based on reported antimicrobial resistance. The primary outcome was preterm birth at < 37 weeks of gestation. Secondary outcomes were composite maternal and neonatal infectious morbidities. RESULTS: 197 women with UTI were eligible for analysis - 68 (34.5%) had pregnancies complicated by “sensitive” uropathogens and 129 (65.5%) had pregnancies complicated by “resistant” uropathogens. In univariate analysis, the rate of preterm birth was not statistically different; 19.1% among women with sensitive uropathogens and 22.5% among women with resistant uropathogens (P=0.58). UTI with a “resistant” uropathogen was not associated with an increased risk of preterm birth in multi-factorial analysis that included risk factors for preterm birth (aOR 1.2, 95% CI 0.58-2.69). We found no statistical difference in composite maternal and neonatal infectious morbidities. CONCLUSION: UTI with a “resistant” uropathogen was not associated with an increased risk for preterm birth nor with composite maternal and neonatal infectious morbidities.