Pyelonephritis In Pregnancy Research Articles

Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy

Symptomatic and asymptomatic bacteriuria is common in pregnant women. A history of previous urinary tract infections and low socioeconomic status are risk factors for bacteriuria in pregnancy. Escherichia coli is the most common aetiologic agent in both symptomatic and asymptomatic infection and quantitative culture is the gold standard for diagnosis. Treatment of asymptomatic bacteriuria has been shown to reduce the rate of pyelonephritis in pregnancy and therefore screening for and treatment of asymptomatic bacteriuria has become a standard of obstetrical care. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of low birth weight, but the methodological quality of the studies limits the strength of the conclusions that can be drawn. Debate exists in the literature as to whether treated pyelonephritis is associated with adverse fetal outcomes. There is no clear consensus in the literature on antibiotic choice or duration of therapy for infection. With increasing antibiotic resistance, consideration of local resistance rates is necessary when choosing therapy.

Acute pyelonephritis in pregnancy: A retrospective study

To examine the incidence, risk factors, microbial pathogens, and pregnancy outcomes of pregnant women with acute antepartum pyelonephritis. Among all pregnant women admitted to Patan Hospital, Nepal from 14 April 2004 to 13 April 2005, pregnant women with acute pyelonephritis were retrospectively studied. Furthermore, the pregnancy outcomes of these women were compared with those of the general obstetric population received at our hospital during the same time period. Of 7034 pregnant women delivered at our hospital, 94 cases of acute antepartum pyelonephritis were diagnosed during the study period (incidence: 1.3%). Maternal mean age for the infection was 22 +/- 3.41 years. Acute pyelonephritis was most frequently occurred in nulliparous women (75%), and in the second trimester (60%). Of 94 cases, 62 (65.95%) showed positive urine culture, with the predominating organism Escherichia coli in 81% (50 of 62) of cases. E. coli was found most sensitive to nitrofurantoin (82.1% of cases), followed by ceftriaxone (81.55% of cases), gentamicin (77.01% of cases), ofloxacin (60.57% of cases), and ciprofloxacin (59% of cases). The incidences of low-birthweight babies (14%) and preterm babies (7.81%) in the cases with acute antepartum pyelonephritis were not significantly different compared to that of all births in our hospital during the same period (13% and 8%, respectively; P > 0.05). Acute pyelonephritis requiring admission to hospital most frequently occurs in nulliparous women, and in the second trimester. The predominating organism responsible for acute pyelonephritis is E. coli. Ceftriaxone, because of its safety and negligible side-effect, should be the drug of choice for acute antepartum pyelonephritis.

Asymptomatic bacteriuria and intimate partner violence in pregnant women

This study was undertaken to determine whether the association of intimate partner violence with urinary tract infection and pyelonephritis in pregnancy is due to a higher rate of asymptomatic bacteriuria in those suffering intimate partner violence. Women enrolling in prenatal care had urine collected for quantitative culture (n = 342) and completed 2 scales with a computer-based survey system: The Conflict Tactics Scale for verbal and physical abuse and the Castro survey for sexual abuse. The prevalence of verbal abuse during pregnancy was 46.9%, physical abuse, 7.6%, sexual abuse 5.8%. No significant associations were seen between quantitative culture of uropathogens and verbal, physical, or sexual abuse. It is unlikely that the reason for the association of urinary tract infection and intimate partner violence is due to a higher number of uropathogens present in the urine of women with verbal, physical, or sexual abuse.

Renal replacement therapy for acute kidney injury in pregnancy

With the liberalization of abortion laws and improved obstetric care in developed countries, acute kidney injury in pregnancy is now an uncommon occurrence [1,2]. Current incidence rates range between 1% and 2.8% [2]. Acute kidney injury requiring renal replacement therapy (RRT) occurs in <1 in 10 000–15 000 pregnancies [1]. Subsequently, there is little to guide the management of such patients. We describe a case of pyelonephritis in pregnancy that led to critical illness and acute kidney injury. It demonstrates pregnancy-induced anatomical and physiological alterations and their effect on diagnosis and management. It serves as a basis for discussion regarding the most appropriate form of RRT in this setting.

Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimesterof pregnancy?

Untreated asymptomatic bacteriuria has been associated with acute pyelonephritis, which may have a role in many maternal and fetal complications. Acute pyelonephritis in pregnancy is related to anemia, septicemia, transient renal dysfunction, and pulmonary insufficiency. A randomized study was conducted to assess the clinical and microbiological efficacy of a single dose of fosfomycin trometamol for the treatment of asymptomatic bacteriuria in the second trimester of pregnancy compared with a 5-day regimen of cefuroxime axetyl. Forty-four women received fosfomycin trometamol and 40 women received cefuroxime axetyl. There were no statistically significant differences between both groups regarding the mean age and mean duration of pregnancy. Therapeutic success was achieved in 93.2% of the patients treated with fosfomycin trometamol vs 95% of those treated with cefuroxime axetyl. A single dose of fosfomycin trometamol is a safe and effective alternative in the treatment of asymptomatic urinary tract infections in the second trimester of pregnancy.

Acute Pyelonephritis in Pregnancy

To examine the incidence of pyelonephritis and the incidence of risk factors, microbial pathogens, and obstetric complications in women with acute antepartum pyelonephritis. For 2 years, information on pregnant women with acute pyelonephritis was collected in a longitudinal study. All women were admitted to the hospital and treated with intravenous antimicrobial agents. We compared the pregnancy outcomes of these women with those of the general obstetric population received at our hospital during the same time period. Four hundred forty cases of acute antepartum pyelonephritis were identified during the study period (incidence 1.4%). Although there were no significant differences in ethnicity, pyelonephritis was associated with nulliparity (44% versus 37%, P = .003) and young age (P = .003). Thirteen percent of the women had a known risk factor for pyelonephritis. Acute pyelonephritis occurred more often in the second trimester (53%), and the predominant uropathogens were Escherichia coli (70%) and gram-positive organisms, including group B beta Streptococcus (10%). Complications included anemia (23%), septicemia (17%), transient renal dysfunction (2%), and pulmonary insufficiency (7%). The incidence of pyelonephritis has remained low in the era of routine prenatal screening for asymptomatic bacteriuria. First-trimester pyelonephritis accounts for over 1 in 5 antepartum cases. Gram-positive uropathogens are found more commonly as pregnancy progresses. Maternal complications continue, but poor obstetrical outcomes are rare.

Acute pyelonephritis in pregnancy in the era of routine antepartum screening for asymptomatic bacteriuria

ANTEPARTUM SCREENING FOR ASYMPTOMATIC BACTERIURIA JAMES HILL, JEANNE SHEFFIELD, F. GARY CUNNINGHAM, GEORGE WENDEL, JR, University of Texas Southwestern Medical Center at Dallas, OB/ Gyn, Fayetteville, NC University of Texas Southwestern Medical Center at Dallas, Obstetrics and Gynecology, Dallas, TX OBJECTIVE: To examine the incidence, risk factors, microbial pathogens, and obstetric complications in women with acute pyelonephritis in the era of routine prenatal screening for asymptomatic bacteriuria (ASB). STUDY DESIGN: Prospective cohort study of all women admitted antepartum with pyelonephritis from January 2000 through December 2001. Diagnosis of pyelonephritis was made by standard clinical and laboratory evaluation. All women were treated with parenteral antibiotics and discharged on microbial suppressive therapy. Follow-up was performed in an obstetric infectious disease clinic. RESULTS: There were 440 women admitted with acute antepartum pyelonephritis during the study period (incidence of 1.1%). Women with pyelonephritis were significantly younger and more likely to be nulliparous (44% versus 37%) compared with the general obstetric population. Thirteen percent had a known risk factor, including a history of pyelonephritis (4%), ASB (3%), and diabetes (2%). Most pyelonephritis (79%) occurred in the second and third trimesters. Overall, 83%of the urine cultures grew E. coli and 12%grew group B Streptococcus and other gram-positive organisms. There was a shift in the microbiologic pattern of uropathogens by trimester with an increase in grampositive organisms later in pregnancy (15%). Anemia (Hct < 30%) was the most common complication (23%), followed by septicemia (17%), respiratory insufficiency (7%), and renal insufficiency (2%). Five percent of women delivered < 37 weeks’ gestation and 7% delivered an infant < 2500 g. CONCLUSION: The incidence of pyelonephritis has remained low with routine prenatal screening for ASB; however, several changes have occurred. First-trimester pyelonephritis now accounts for over 1 in 5 antepartum cases. Gram-positive uropathogens are found more commonly as pregnancy progresses and may influence antimicrobial choices and efficacy. Maternal complications continue; however, excess poor obstetrical outcomes are rare.

Uterine contraction frequency during treatment of pyelonephritis in pregnancy and subsequent risk of preterm birth

To assess ceftriaxones effect on uterine contraction frequency and determine risk factors for subsequent preterm birth in women with pyelonephritis. Seventy-one women with pyelonephritis at greater than 24 weeks' gestation with continuous external tocodynamometry after antibiotic administration were studied. Patients received 2 doses of ceftriaxone 1 gram intramuscularly at 24-hour intervals. Temperatures, timing of antibiotic administration, and gestational age at delivery were recorded. Uterine contraction frequency was measured for the hour prior to antibiotic administration, as well as the six hours after. Uterine activity steadily and significantly decreased from a mean of 5.1 +/- 7.3 at presentation to 2.0 +/- 2.9 uterine contractions per hour (P = .04, student t-test) six hours after ceftriaxone administration. The maximal number of contractions per hour each woman experienced did not correlate with temperature (r = .02, linear regression analysis). Uterine contractility and recurrent urinary tract infection were both associated with subsequent preterm birth (P = .004 and .016 respectively using nominal logistic regression analysis). (1) A significant decrease in uterine activity from baseline occurs after ceftriaxone administration for acute pyelonephritis in pregnancy. (2) Temperature elevations are not associated with increased uterine activity. (3) Patients with significant uterine activity or recurrent urinary tract infection are at risk for preterm birth.

Outpatient Treatment Evolves for Pyelonephritis in Pregnancy

Outpatient Treatment Evolves for Pyelonephritis in Pregnancy

Antibiotics for asymptomatic bacteriuria in pregnancy.

Up to 30% of mothers develop acute pyelonephritis if asymptomatic bacteriuria is untreated. Asymptomatic bacteriuria may have a role in preterm birth, or it may be a marker for low socioeconomic status and thus, low birth weight. The objective of this review was to assess the effect of antibiotic treatment for asymptomatic bacteriuria on persistent bacteriuria during pregnancy, the risk of preterm delivery and the development of pyelonephritis after delivery. I searched the Cochrane Pregnancy and Childbirth Group trials register. Randomised trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Trial quality was assessed. Thirteen studies were included. Overall the study quality was not strong. Antibiotic treatment compared to placebo or no treatment was effective in clearing asymptomatic bacteriuria (odds ratio 0.07, 95% confidence interval 0.05 to 0.10). The incidence of pyelonephritis was reduced (odds ratio 0.25, 95% confidence interval 0.19 to 0.32). Antibiotic treatment was also associated with a reduction in the incidence of preterm delivery or low birth weight babies (odds ratio 0.60, 95% confidence interval 0.45 to 0.80). Antibiotic treatment appears to be effective in reducing the risk of pyelonephritis in pregnancy. An apparent reduction in preterm delivery is consistent with current theories about the role of infection in preterm birth, but this association should be interpreted with caution.

Pyelonephritis in pregnancy: treatment options for optimal outcomes.

Acute pyelonephritis is one of the most common indications for antepartum hospitalisation. When acute pyelonephritis is diagnosed, conventional treatment includes intravenous fluid and parenteral antibacterial administration. There are limited data by which to assess the superiority of one antibacterial regimen over the other in terms of efficacy, patient acceptance and safety for the developing fetus. There is a small body of evidence to support the ambulatory treatment of pregnant women with pyelonephritis in the first and early second trimesters.

Outpatient treatment of acute pyelonephritis in pregnancy after 24 weeks

Objective: To compare outpatient to inpatient management of acute pyelonephritis in pregnancy beyond 24 weeks’ gestation. Methods: Ninety-two gravidas past 24 weeks’ gestation, randomized to outpatient or inpatient therapy, received two 1-g doses of intramuscular ceftriaxone at 24-hour intervals while hospitalized, then were discharged and reevaluated within 48–72 hours or remained hospitalized until afebrile for 48 hours. Subjects received oral cephalexin after initial treatment. Urine cultures were done on admission and 5–14 days after therapy. Surveillance continued until delivery. We anticipated that 15% of outpatients and 0.01% of inpatients would require changes in antibiotic therapy. Results: Twenty-one percent of women evaluated were excluded. Thirteen of 46 (28%) outpatients’ hospitalization exceeded 24 hours. Six outpatients (13.0%) and one inpatient did not respond to initial therapy and were treatment failures (relative risk [RR] 1.82, 95% confidence interval [CI] 1.00, 3.31). Within 2 weeks of initial therapy, seven of 81 (8.6%) subjects had positive urine cultures, four outpatients versus three inpatients ( P > .999). Eleven of 84 (13.1%) deliveries for which birth data were available occurred preterm (six of 41 outpatients versus five of 43 inpatients) (RR 1.14, 95% CI 0.61, 2.11). Conclusion: There were no significant differences in clinical responses or birth outcomes of inpatients or outpatients treated for acute pyelonephritis after 24 weeks’ gestation if they completed their assigned protocols. Thirty percent of outpatients were unable to, and most women with acute pyelonephritis in the third trimester were not candidates for outpatient therapy.

Outpatient Treatment of Acute Pyelonephritis in Pregnancy After 24 Weeks

Outpatient Treatment of Acute Pyelonephritis in Pregnancy After 24 Weeks

A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy: Wing D.A.; Hendershott C.M.; Debuque L.; Millar L.K. USA Obstet Gynecol 1998 92/2 (249–253)

A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy: Wing D.A.; Hendershott C.M.; Debuque L.; Millar L.K. USA Obstet Gynecol 1998 92/2 (249–253)

A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy

Objective: To compare the effectiveness of three antibiotic regimens for the treatment of acute pyelonephritis in pregnancy. Methods: One hundred seventy-nine pregnant women earlier than 24 weeks’ gestation who had acute pyelonephritis were randomized to 1) intravenous (IV) ampicillin and gentamicin, 2) IV cefazolin, or 3) intramuscular ceftriaxone. All participants then completed 10-day courses of oral cephalexin after primary treatment. A urine culture was performed on admission and 5–14 days after completion of therapy. Surveillance for persistent or recurrent infection and obstetric complications continued until delivery. On the basis of a two-sided hypothesis test and with α = .025, 60 subjects were needed in each group for statistical power greater than 80% to detect a difference between ceftriaxone and other antibiotics if hospital length of stay differed by 1 or more days. Results: The treatment groups were similar in age, parity, temperature, gestational age, and initial white blood cell count. There were no statistically significant differences in length of hospitalization, hours until becoming afebrile, days until resolution of costovertebral angle tenderness, or infecting organism. There were no statistically significant differences in birth outcomes between the three groups. The average (standard deviation) age at delivery was 38.8 ± 3.6 weeks. The average birth weight was 3274 ± 523 g. Eleven (6.9%) of 159 subjects delivered prematurely. Escherichia coli was the most common uropathogen isolated (137 of 179, 76.5%). Blood cultures were positive for organisms in 15 cases (8.4%). At follow-up examination within 2 weeks of initial therapy, eight (5.0%) of 159 subjects had urine cultures positive for organisms. Ten women (6.3%) had cultures positive for organisms later in their antepartum course, and 10 other participants (6.3%) developed recurrent pyelonephritis. Conclusion: There are no significant differences in clinical response to antimicrobial therapy or birth outcomes among subjects treated with ampicillin and gentamicin, cefazolin, or ceftriaxone for acute pyelonephritis in pregnancy before 24 weeks’ gestation.

A Randomized Trial of Three Antibiotic Regimens for the Treatment of Pyelonephritis in Pregnancy

A Randomized Trial of Three Antibiotic Regimens for the Treatment of Pyelonephritis in Pregnancy

Improving the Processes of Care and Outcomes in Obstetrics/Gynecology

The obstetrics/gynecology department of York Hospital (York Health System, York, Pennsylvania) initiated a program to improve the processes of care and control costs for common women's and newborns' health care services. Twelve clinical policies were established between June 1993 and February 1995. CONDUCTING THE QUALITY IMPROVEMENT (QI) PROJECTS: Using the plan-do-check-act (PDCA) improvement cycle method, the QI group established clinical pathways for high-volume conditions or procedures known to have low rates of complications and clinical guidelines for those conditions or procedures not requiring coordinated efforts of a group of health care professionals. EXAMPLE--PYELONEPHRITIS IN PREGNANCY: The literature had indicated that the prevalence of pyelonephritis can be decreased by identifying and treating asymptomatic bacteriuria early in prenatal care. After the validity of the clinical policy was demonstrated in the resident service, the policy was extended to all private obstetric practices. Dissemination of the finding that most of the admissions for pyelonephritis were for referred patients (for whom we had no control over prenatal care) or for patients referred by private physicians who were not yet following the guidelines quickly led to complete compliance by our obstetricians and other health care providers referring patients to the York Health System. The 12 clinical policies resulted in the elimination of 113 admissions and 5,595 inpatient days and in the reduction of the cost of patient care by $1,306,214 for the years 1994-1995 and 1995-1996 combined, without apparent adverse effects on patient health. A voluntary clinical policies program can change the culture of a department and lead to cost-effectiveness and better quality of patient care.

Acute Renal Failure in Pregnancy

From 1976 to 1994, 57 women were referred to the Centro de Nefrología, Montevideo, with obstetric acute renal failure (ARF). The main causes were hypertensive disorders such as preeclampsia (PE) in 27, acute pyelonephritis of pregnancy (APN) in 26, and idiopathic postpartum renal failure in 3. Severe preeclampsia superimposed on chronic hypertension and acute pyelonephritis of pregnancy complicated by sepsis accounted for more than 50% of the cases of ARF. Chronic renal failure developed in 6 patients: 2 had bilateral renal cortical necrosis, 1 had malignant nephrosclerosis, and 3 had idiopathic postpartum renal failure. Maternal mortality related to ARF was low in this group of patients (less than 2%). In contrast, perinatal mortality was strikingly high (40%).

The results and substantiation of surgical policy in the management of acute pyodestructive pyelonephritis in pregnancy

The results and substantiation of surgical policy in the management of acute pyodestructive pyelonephritis in pregnancy

Acute pyelonephritis in pregnancy: a randomized study of three antibiotic treatment regimens.

Acute pyelonephritis in pregnancy: a randomized study of three antibiotic treatment regimens.