Risk Of Pyelonephritis Research Articles

Increased water intake dilutes protective uromodulin levels in urine and results in increased rates of pyelonephritis in a murine model.

Urinary tract infections (UTIs) rank among the most prevalent infections in humans, carrying substantial implications for public health. Women experiencing recurrent UTIs are often advised to boost their fluid intake to help eliminate bacteria. In this study, we explored the impact of elevated fluid consumption during UTIs using a mouse model of pyelonephritis. UTI was induced in 8-10 w female BALB/cJ-mice by surgically injecting Escherichia coli (O6:K13:H1) into the bladder whereafter mice were randomized to gel food (GF) or regular chow. Immune response and infection severity were determined 24-h post-infection. Invitro bacterial growth (OD600) was determined in urine from mice or from human volunteers. Gel feeding increased urine output (1.40 ± 0.77 μL min-1, p < 0.01) and diluted the urine (668.7 ± 177 mOsmol kg-1, p < 0.0001) compared to controls on regular chow (urine output: 0.34 ± 0.27 μL min-1, osmolality: 1439 ± 473.5 mOsmol kg-1). Mice on GF had a higher risk of pyelonephritis (87.5%) and more severe infections (26.22 ± 9.88 CFU mg-1 tissue) compared to controls (43.75%; 3.87 ± 3.56 CFU mg-1, p < 0.01). Correspondingly, the growth of E.coli was markedly reduced at osmolalities above 1200 mOsmol kg-1 compared to 600 mOsmol kg-1 and GF mice had lower urine levels of uromodulin (13.70 ± 1.89 μg mL-1, p < 0.01) compared to controls (24.65 ± 2.70 μg mL-1). Increased water intake and urine flow in mice will markedly increase the risk of pyelonephritis. The increased risk may reflect reduced urine uromodulin combined with optimized growth conditions for E. coli. The study does not immediately support the notion that established UTIs can be eliminated by increased water intake.

Infection and Sepsis Trends during United States' Delivery Hospitalizations from 2000 to 2020.

This study aimed to evaluate trends, risk factors, and outcomes associated with infections and sepsis during delivery hospitalizations in the United States. The 2000-2020 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with and without infection and sepsis were identified. Common infection diagnoses during delivery hospitalizations analyzed included (i) pyelonephritis, (ii) pneumonia/influenza, (iii) endometritis, (iv) cholecystitis, (v) chorioamnionitis, and (vi) wound infection. Temporal trends in sepsis and infection during delivery hospitalizations were analyzed. The associations between sepsis and infection and common chronic health conditions including asthma, chronic hypertension, pregestational diabetes, and obesity were analyzed. The associations between clinical, demographic, and hospital characteristics, and infection and sepsis were determined with unadjusted and adjusted logistic regression models with unadjusted odds ratio (OR) and adjusted odds ratios with 95% confidence intervals as measures of association. An estimated 80,158,622 delivery hospitalizations were identified and included in the analysis, of which 2,766,947 (3.5%) had an infection diagnosis and 32,614 had a sepsis diagnosis (4.1 per 10,000). The most common infection diagnosis was chorioamnionitis (2.7% of deliveries) followed by endometritis (0.4%), and wound infections (0.3%). Infection and sepsis were more common in the setting of chronic health conditions. Evaluating trends in individual infection diagnoses, endometritis and wound infection decreased over the study period both for patients with and without chronic conditions, while risk for pyelonephritis and pneumonia/influenza increased. Sepsis increased over the study period for deliveries with and without chronic condition diagnoses. Risks for adverse outcomes including mortality, severe maternal morbidity, the critical care composite, and acute renal failure were all significantly increased in the presence of sepsis and infection. Endometritis and wound infections decreased over the study period while risk for sepsis increased. Infection and sepsis were associated with chronic health conditions and accounted for a significant proportion of adverse obstetric outcomes including severe maternal morbidity. · Sepsis increased over the study period for deliveries with and without chronic condition diagnoses.. · Endometritis and wound infection decreased over the study period.. · Infection and sepsis accounted for a significant proportion of adverse obstetric outcomes..

The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study.

The risk of pyelonephritis following uncomplicated lower urinary tract infection (cystitis) in women has not been studied in well-powered samples. This is likely due to the previous lack of nationwide primary healthcare data. We aimed to examine the risks of pyelonephritis following cystitis in women and explore if antibiotic treatment, cervical cancer, parity, and sociodemographic factors are related to these risks. This was a nationwide cohort study (2006-2018) of 752,289 women diagnosed with uncomplicated cystitis in primary healthcare settings. Of these, 404 696 did not redeem an antibiotic prescription within five days from cystitis. Logistic regression models were used to calculate odds ratios for pyelonephritis within 30 days and 90 days following the cystitis event. Around one percent (7454) of all women with cystitis were diagnosed with pyelonephritis within 30 days, of which 78.2% had not redeemed an antibiotic for their cystitis. Antibiotic treatment was inversely associated with both outpatient registration and hospitalization due to pyelonephritis, with odds ratios of 0.85 (95% CI 0.80 to 0.91) and 0.65 (95% CI 0.55 to 0.77), respectively. Sociodemographic factors, parity, and cervical cancer were, with few exceptions (e.g., age and region of residency), not associated with pyelonephritis. Antibiotic treatment was inversely associated with pyelonephritis, but the absolute risk reduction was low. Non-antibiotic treatment for cystitis might be a safe option for most women. Future studies identifying the women at the highest risks will help clinicians in their decision making when treating cystitis, while keeping the ecological costs of antibiotics in mind.

HLA as risk and protection antigens against urinary tract diseases

Abstract. Currently, there is no doubt about the feasibility of determining the frequency of HLA and analysis of genetic associations, including those that determine the state of immunity, in patients with the genitourinary disease.&#x0D; The study aimed to evaluate HLA phenotypes in patients with the most common diseases of the genitourinary system and identify risk antigens or protectors.&#x0D; Methods. HLA distribution was studied in 384 patients with pyelonephritis and glomerulonephritis and 464 patients with urological diseases (chronic cystitis, chronic proliferative cystitis, chronic prostatitis, prostate sclerosis, prostatic hyperplasia, and prostate cancer). HLAs were defined using a standard microlymphocytotoxic test (Terasaki’s test) on the Terasakiґs planchette with panels of anti-HLA serums (20 antigens of locus A, 31 – B and 9 – DR). The control group consisted of 350 healthy donors from Ukraine.&#x0D; The HLA frequencies in healthy and diseased subjects were compared taking each antigen separately, using the χ2 test. The value of the relative risk of disease (RR) was determined by the coefficient: RR = ab/cd, where a is the number of patients positive for this antigen, b is the number of persons in control, negative for this antigen; c is the number of patients negative for this antigen, d is the number of persons in control positive for this antigen. Indicators RR≥ 2.0 were considered significant.&#x0D; Absolute (attributive) risk of the disease as an etiological fraction, which was determined by the formula: s = x - y/1 - y, where x is the frequency of antigen in patients, y is the frequency in healthy people. The indicator s&gt; 0,1 was considered reliable.&#x0D; Results. The association of the most common genitourinary diseases with certain histocompatibility antigens (RR≥2) is shown. The causal role of HLA with a significant absolute risk of pyelonephritis (А10, А11; В14, В16) and glomerulonephritis (A24, А28; B8; DR4, DR52), chronic cystitis, (including proliferative) (A10, B14, B16), chronic prostatitis (including with an autoimmune component or impaired fertility) (А24, В8, В52), sclerosis of the prostate (А24, А28), hyperplasia (А29, В38) and prostate cancer (А25, А29, В40, В44, В49) has been established. HLA-antigens associated with protection against these pathologies have also been identified - А2, А24, В21, В35 for pyelonephritis and А9, В12, В16, В18 for glomerulonephritis; А25, А26, В5, В14, В16, В17 for chronic prostatitis with its complications, А10, B15, B17 for prostate sclerosis, А9, А10, В17 for prostate hyperplasia, A1, B5, B13, B15 for prostate cancer.&#x0D; Conclusion. The study proves the feasibility of identifying antigens of the HLA system and analysis of their associations with different genitourinary diseases, which allows for predicting the risks of the disease and treatment optimization.

Bacteriuria in pregnancy in Sanglah Hospital: a descriptive study

Introduction: Bacteriuria in pregnancy is quite common, with the prevalence of asymptomatic bacteriuria occurring in about 2-5% of pregnancies, acute cystitis occurring in 1.3% of pregnancies and acute pyelonephritis occurring in about 3%. If not treated properly, asymptomatic bacteriuria can increase the risk of pyelonephritis and the incidence of low birth weight (LBW). This study aims to describe the characteristics of patients with bacteriuria in pregnant women at Sanglah Hospital. Acknowledging the characteristics of patients with bacteriuria may help the screening process establish an early diagnosis and management. Methods: This study is a retrospective descriptive study carried out at Sanglah Hospital Denpasar from January 2018 to January 2020. Pregnant women diagnosed with bacteriuria in pregnancy from January 2018 to January 2020 at Sanglah Hospital Denpasar who had met the inclusion criteria and did not meet the exclusion criteria were included in the study. Data regarding the patient’s age, gestational age when bacteriuria was diagnosed, UTI complaints, bacterial urine levels, and culture results were collected for each subject. Results: Based on the results of this study, it was found that the prevalence of positive bacteriuria from January 2018 to 2020 was 0.89%. Most of the pregnant women diagnosed with bacteriuria were aged 20-35 years (77.1%), had gestational age of 0 - 28 weeks (64.9%), were multigravida (52.7%), and had high school education level (50.8%). The majority of pregnant women who experience bacteriuria were included in the group of asymptomatic bacteriuria (64.9%). The urinalysis results on pregnant women with bacteriuria showed that most of the pregnant women (45.6%) had +1 bacteria levels, followed by +2 and +3 bacteria levels, namely 28% and 26.4%, respectively. Conclusion: Bacteriuria in pregnancy is still a problem that is often encountered in daily practice

Bad bugs: antibiotic-resistant bacteriuria in pregnancy and risk of pyelonephritis

The introduction of antibiotics has significantly reduced morbidity and mortality from microbial infections, but the rise of antibiotic-resistant and multidrug-resistant microbes is of increasing clinical concern. Few studies have examined the prevalence and impact of antibiotic resistance in common antenatal infections. This study aimed to determine whether pregnant women with a urine culture positive for antibiotic-resistant or multidrug-resistant gram-negative bacteria are at increased risk of developing pyelonephritis than pregnant women infected with antibiotic-susceptible organisms. This was a retrospective cohort study of pregnant women with asymptomatic bacteriuria or acute cystitis from a single health system from July 2013 to May 2019. Women with gram-negative antibiotic-resistant (resistance to 1-2 antibiotic classes) and multidrug-resistant (resistance to ≥3 antibiotic classes) lower urinary tract infections were compared with women with antibiotic-susceptible urinary tract infections in terms of demographic, infectious, antepartum, and intrapartum data. The primary outcome was pyelonephritis, defined as a billing code for pyelonephritis plus fever or flank pain. The secondary outcomes were length of stay in the hospital because of pyelonephritis, a composite of pyelonephritis complications (renal abscess, sepsis, and intensive care unit admission), and preterm delivery. The differences in the primary outcome were analyzed using multivariate logistic regression. A total of 573 women were eligible for inclusion. Of the 573 women, 334 (58%) had gram-negative bacteria on urine culture. Of the 334 cases, 173 (52%) were antibiotic susceptible, 74 (22%) were antibiotic resistant, and 87 (26%) were multidrug resistant. Women with antibiotic-resistant and multidrug-resistant infections were more likely to have hypertension (P=.004), to be Black (P=.03), to have public insurance (P=.002), and to experience more urinary infections (P=.001). Pyelonephritis was more common in women with antibiotic-resistant (adjusted odds ratio, 2.27; 95% confidence interval, 1.08-4.78) and multidrug-resistant (adjusted odds ratio, 3.06; 95% confidence interval, 1.57-5.96) infections than in women with antibiotic-susceptible urinary tract infections. Length of stay, preterm delivery, and pyelonephritis complications did not differ between antibiotic-susceptible and antibiotic-resistant and multidrug-resistant infections. In an age of increasing antibiotic resistance, more than one-half of pregnant women with bacteriuria experience at least 1 infection with an antibiotic-resistant organism. These resistance patterns have a real clinical impact as pregnant women with antibiotic-resistant gram-negative lower urinary tract infections have an estimated 2- to 3-fold increased odds of developing pyelonephritis.

Coagulase-negative Staphylococci: a rare cause of urinary tract infections in children with consequences on clinical practice.

Isolation of coagulase-negative Staphylococci (CoNS) in urine cultures of children is usually considered a contamination of the sample, except for Staphylococcus saprophyticus in older children. The aim of this study was to describe the characteristics of children in whom CoNS was considered a true urinary pathogen. The medical records of all children aged 0 to 18years at Shaare Zedek Medical Center between 2013 and 2020 who were diagnosed with CoNS urinary tract infection (UTI) were reviewed for demographic, clinical, and laboratory data. CoNS were identified as the causative organism of UTIs in 30 children, none of whom was bacteremic. Male sex, younger age, and infection with non-S. saprophyticus CoNS were associated with higher risk of pyelonephritis in comparison to cystitis. Eleven (37%) children had previously known or newly diagnosed underlying urinary tract abnormalities. All patients recovered. CoNS were found to be an uncommon urinary pathogen among children but can cause pyelonephritis, especially in young children and in males.Conclusion: The finding of CoNS pyelonephritis requires thorough search for urinary abnormalities.

Asymptomatic bacteriuria and pyelonephritis during pregnancy

The most common extragenital pathology during pregnancy is urinary tract infection (UTI) of various localization. In some cases, untreated UTI can contribute to the development of obstetric, urological, and perinatal pathologies. Factors predisposing to the UTI manifestation may include increased progesterone, delayed peristalsis, urine retention in the ureters, uterine growth, bladder displacement, and increased residual urine volume. Asymptomatic bacteriuria (ASB) during pregnancy can increase the risk of pyelonephritis and subsequent maternal and fetal complications. Pregnant women should be screened for ASB at least once at the beginning of pregnancy (aft er 14 weeks). E.coli is the dominant uropathogen in 70 – 95% of UTI cases in pregnant women. The main treatment for ABT and pyelonephritis in pregnancy (PiP) is antibiotic therapy (ABT), which is prescribed empirically in most cases. There is currently no consensus on the choice of ABT and the duration of treatment for UTI in pregnant women. In the case of ineff ective drug therapy of PiP, it is necessary to raise the issue of the upper urinary tract drainage promptly.

Outcomes of kidney-transplanted patients with history of intestinal reconstruction of the urinary tract.

BackgroundDue to increased risk of pyelonephritis, patients with intestinal reconstruction of the lower urinary tract (IRLUT) have long been advised against kidney transplantation. The aim of this study was to compare the outcomes of transplantation between patients with IRLUT and patients with normal LUT (NLUT) using propensity score matching method.MethodsThe study included 23 kidney recipients with IRLUT matched to 46 kidney recipients with NLUT using known allograft survival and pyelonephritis risk factors as covariates. One‐, 5‐, and 10‐year graft survival, pyelonephritis, and surgical complications occurrence and graft function were compared.ResultsOne‐, 5‐, and 10‐year graft survival were 96%, 91%, and 63% in the IRLUT group and 96%, 88%, and 70% in the NLUT group, respectively (p = 0.72). Patients with IRLUT had increased cumulative risk of pyelonephritis at 10 years (70% vs. 19%; log‐rank < 0.01) without impacting graft function or rejection occurrence. There was no difference in overall surgical complication, but patients with IRLUT had more urological complications than patients with NLUT (62% vs. 28%; p < 0.01).ConclusionsOur case‐control study consolidates the results regarding the safety of transplantation in patients with IRLUT using a strong validated matching method and provides new insights regarding graft function, pyelonephritis, and surgical complications in this population.

Sociodemographic factors and uncomplicated pyelonephritis in women aged 15-50 years: a nationwide Swedish cohort register study (1997-2018)

Objective: To study the relationship between sociodemographic factors and pyelonephritis.Methods: A nationwide open cohort study consisting of 2,052,873 women (76.2% Swedish-born) aged 15-50 years was conducted (1997-2018). The outcome was the first event of acute uncomplicated pyelonephritis diagnosed in primary healthcare settings in relation to the sociodemographic factors. Cox regression models were used in the analyses.Results: The study identified 40,724 cases. In the fully adjusted model, women from non-Western countries had a higher risk of pyelonephritis compared to Swedish-born women. Women from Latin America/the Caribbean had the highest risk (Hazard ratio = 1.60; 95% CI 1.49-1.72), followed by Eastern Europe (HR = 1.26; 95% CI 1.21-1.32) and the Middle East/North Africa (HR = 1.25; 95% CI 1.19-1.30). Low education, low income, urban living, and young age were also associated with higher risks of pyelonephritis.Conclusion: This study presents novel risk factors associated with pyelonephritis. Women from non-Western countries and with low socioeconomic status might disproportionately suffer from this serious infection. This might be due to biological predispositions and the fact that immigrant women do not acquire the same level of health or might receive less healthcare compared to native women, even in the presence of universal healthcare.

Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.

Acute uncomplicated urinary tract infections (UTIs) are among the most common indications for antibiotic prescriptions in otherwise healthy women. We compared the risk of treatment failure of antibiotic regimens for outpatient treatment of UTI in real-world practice. We identified non-pregnant, premenopausal women diagnosed with uncomplicated, lower tract UTI and prescribed an oral antibiotic with activity against common uropathogens. We used propensity score-weighted Kaplan-Meier functions to estimate 30-day risks and risk differences (RD) for pyelonephritis and UTI-related antibiotic prescription switch. Of 1 140 602 patients, the distribution of index prescriptions was 44% fluoroquinolones (non-first-line), 28% trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), 24% nitrofurantoin (first-line), 3% narrow-spectrum β-lactams (non-first-line), 1% broad-spectrum β-lactams (non-first-line), and 1% amoxicillin/ampicillin (non-recommended). Compared to the risk of pyelonephritis for nitrofurantoin (0.3%), risks were higher for TMP/SMX (RD, 0.2%; 95% CI, 0.2%-0.2%) and broad-spectrum β-lactams (RD, 0.2%; 95% CI, 0.1%-0.4%). Compared to the risk of prescription switch for nitrofurantoin (12.7%), the risk was higher for TMP/SMX (RD 1.6%; 95% CI 1.3%-1.7%) but similar for broad-spectrum β-lactams (RD -0.7%; 95% CI -1.4%-0.1%) and narrow-spectrum β-lactams (RD -0.3%; 95% CI -0.8%-0.2%). Subgroup analyses suggest TMP/SMX treatment failure may be due in part to increasing uropathogen resistance over time. The risk of treatment failure differed by antibiotic agent, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams. Given serious safety warnings for fluoroquinolones, these results suggest that nitrofurantoin may be preferable as the first-line agent for outpatient treatment of uncomplicated UTI.

Lower Urinary Pathogens: Do More Pathogenic Bacteria Increase the Risk of Pyelonephritis?

Outside of pregnancy, urinary pathogens such as Proteus and Klebsiella are considered more pathogenic than E. coli. During pregnancy, the implications of lower urinary tract infection (LUTI) with more pathogenic bacteria are unclear. Thus, we sought to compare the risk of progression from LUTI to pyelonephritis among women infected with these more pathogenic urinary bacteria to those infected with E. coli. Retrospective cohort of pregnant women with LUTI at single tertiary center from July 2013 to May 2019. Pathogenic infections (PI) were defined as asymptomatic bacteriuria or acute cystitis urinary cultures positive for Proteus, Klebsiella, Enterobacter, Citrobacter, Acinetobacter, Staphylococcus, or Raoultella species. Demographic, infectious, antepartum, and postpartum data abstracted. Pregnant women with PI compared with those with E. coli. Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis length of stay (LOS) >6 days, preterm birth (PTB), low birthweight (LBW), and measures of pyelonephritis-related morbidity. Of 686 pregnant women with LUTIs, 313 had urine culture growing out either PI or E. coli, with 59 (12%) growing PI and 254 (54%) growing E. coli. Women with PI were more likely to be African American, have chronic hypertension, and have history of preeclampsia. The primary species causing PI were Klebsiella (n = 29) and Proteus (n = 11). PI were not more likely to progress to pyelonephritis than E. coli LUTIs (10.9 vs. 14.5%; p = 0.67). Median LOS for pyelonephritis and other measures of pyelonephritis-related morbidity did not differ nor did PTB or LBW rates. After controlling for race, body mass index, history of preeclampsia, and history of pyelonephritis, PI were not associated with increased odds of progression to pyelonephritis (adjusted odds ratio: 0.69, 95% confidence interval: 0.27-1.80). Bacteria traditionally considered to be more pathogenic outside of pregnancy do not progress to pyelonephritis at higher rates than E. coli in pregnancy, and are associated with similar pyelonephritis-related morbidity. Larger studies are needed to confirm these findings. · Little is known about impact of uropathogen on progression to pyelonephritis and obstetric outcomes.. · Rates of progression to pyelonephritis from UTI did not vary by uropathogen.. · Pyelonephritis-related morbidities and preterm birth rates were also similar among uropathogens..

Asymptomatic bacteriuria in antenatal women attending tertiary care hospital at Hyderabad

Urinary tract infection (UTI) is one of the most common bacterial infections during pregnancy. Increased risk of UTI in pregnant women is due to anatomical changes and physiological adaptations during pregnancy.Untreated asymptomatic bacteriuria (ASB) in pregnancy predisposes to symptomatic UTI in 25% of infected women.Early diagnosis and appropriate treatment of ASB curbs the risk of pyelonephritis, ecclampsia, preterm delivery and adverse fetal outcomes. This prospective study was conducted to determine the occurrence of ASB, its etiological agents and their antibacterial susceptibility pattern in selected group of pregnant women. Prospective study was carried out on in department of Microbiology at ESIC medical college, Telangana from September 2016 to March 2017. Study population included total of 346 antenatal women of gestational ages 28 weeks or less with no symptoms of urinary tract infection (UTI) attending for antenatal checkup. All bacterial isolates showing significant growth were identified by standard biochemical methods. The antibiotic sensitivity testing of the isolates was be done by Kirby Bauer method according to CLSI guidelines. Among total of 346 antenatal women screened 85.5% samples were sterile. Significant bacterial growth was found in 38 (11%) cases. The age, gravida and trimester of participants did not have any statistical significance on ASB in present study. Escherichia coli (42.1%) and Enterococcus faecalis (42.1%) were most common isolates. Antibiotic sensitivity pattern of Escherichia coli revealed good sensitivity to cefotaxime (93.75%), amikacin (87.5%), nitrofurantoin (87.5%) and cotrimoxazole (81%). Antibiotic sensitivity pattern of Enterococcus faecalis showed good sensitivity of 75% to nitrofurantoin and 67.5% to ampicillin, ciprofloxacin and high level gentamicin. Staphylococcus aureus showed 100% sensitivity to betalactam antibiotics and aminoglycoside.Every pregnant woman in each trimester should have a urine culture done and detected cases should be treated according to the antibiotic susceptibility test in order to reduce the perinatal and maternal morbidity and mortality.

Accuracy of subjective vesicoureteral reflux timing assessment: supporting new voiding cystourethrogram guidelines.

Bladder volume at the onset of vesicoureteral reflux (VUR) is an important prognostic indicator of spontaneous resolution and the risk of pyelonephritis. We aim to determine whether pediatric urologists and pediatric radiologists can accurately estimate the timing of reflux by examining voiding cystourethrogram (VCUG) images without prior knowledge of the instilled contrast volume. Total bladder volume and the volume at the time of reflux were collected from VCUG reports to determine the volume at the onset of VUR. Thirty-nine patients were sorted into three groups: early-/mid-filling reflux, late-filling and voiding only. Thirty-nine images were shown to three pediatric urologists and two pediatric radiologists in a blinded fashion and they were then asked to estimate VUR timing based on the above categories. A weighted kappa statistic was calculated to assess rater agreement with the gold standard volume-based report of VUR timing. The mean patient age at VCUG was 3.1±2.9months, the median VUR was grade 3, and 20 patients were female. Overall agreement among all five raters was moderate (k=0.43, 95% confidence interval [CI] 0.36-0.50). Individual agreement between rater and gold standard was slight to moderate with kappa values ranging from 0.13 to 0.43. Pediatric radiologists and urologists are unable to accurately and reliably characterize VUR timing on fluoroscopic VCUG. These findings support the recently published American Academy of Pediatrics protocol recommending the routine recording of bladder volume at the onset of VUR as a standard component of all VCUGs to assist in a more accurate assessment of the likelihood of resolution and risk of recurrent urinary tract infections.

Receiving Continuous Antibiotic Prophylaxis

Abstract Continuous antibiotic prophylaxis represents an initial management strategy for decreasing the risk of urinary tract infections in children with vesicoureteral reflux. A significant number of cases resolve spontaneously in time, reason for which continuous antibiotic prophylaxis is not required in every patient with this disorder. It is mandatory to select the patients who need continuous antibiotic prophylaxis according to their risk group. We do not have a lot of scientific evidences about what is better or not for these patients, but the main objective for the case management is to maintain the renal function, by minimizing the risk of pyelonephritis, renal scars and its consequences such as hypertension or renal failure. The selection of these patients who do not require continuous antibiotic prophylaxis is difficult, and the prophylaxis remains the safest method in most of the cases. To take the best decisions for our patients, it is important to consider the last published guidelines and studies.

1069: Bad bugs: antibiotic-resistant lower urinary tract infections and risk of pyelonephritis in pregnancy

1069: Bad bugs: antibiotic-resistant lower urinary tract infections and risk of pyelonephritis in pregnancy

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

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)

470: Lower urinary pathogens: Do more virulent bacteria increase the risk of pyelonephritis?

470: Lower urinary pathogens: Do more virulent bacteria increase the risk of pyelonephritis?

Antibiotics for asymptomatic bacteriuria in pregnancy.

Asymptomatic bacteriuria is a bacterial infection of the urine without any of the typical symptoms that are associated with a urinary infection, and occurs in 2% to 15% of pregnancies. If left untreated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. This is an update of a review last published in 2015. To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 4 November 2018, and reference lists of retrieved studies. Randomised controlled trials (RCT) comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Trials using a cluster-RCT design and quasi-RCTs were eligible for inclusion, as were trials published in abstract or letter form, but cross-over studies were not. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. We included 15 studies, involving over 2000 women. Antibiotic treatment compared with placebo or no treatment may reduce the incidence of pyelonephritis (average risk ratio (RR) 0.24, 95% confidence interval (CI) 0.13 to 0.41; 12 studies, 2017 women; low-certainty evidence). Antibiotic treatment may be associated with a reduction in the incidence of preterm birth (RR 0.34, 95% CI 0.13 to 0.88; 3 studies, 327 women; low-certainty evidence), and low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; 6 studies, 1437 babies; low-certainty evidence). There may be a reduction in persistent bacteriuria at the time of delivery (average RR 0.30, 95% CI 0.18 to 0.53; 4 studies; 596 women), but the results were inconclusive for serious adverse neonatal outcomes (average RR 0.64, 95% CI 0.23 to 1.79, 3 studies; 549 babies). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes, and maternal adverse effects were rarely described. Overall, we judged only one trial at low risk of bias across all domains; the other 14 studies were assessed as high or unclear risk of bias. Many studies lacked an adequate description of methods, and we could only judge the risk of bias as unclear, but in most studies, we assessed at least one domain at high risk of bias. We assessed the quality of the evidence for the three primary outcomes with GRADE software, and found low-certainty evidence for pyelonephritis, preterm birth, and birthweight less than 2500 g. Antibiotic treatment may be effective in reducing the risk of pyelonephritis in pregnancy, but our confidence in the effect estimate is limited given the low certainty of the evidence. There may be a reduction in preterm birth and low birthweight with antibiotic treatment, consistent with theories about the role of infection in adverse pregnancy outcomes, but again, the confidence in the effect is limited given the low certainty of the evidence. Research implications identified in this review include the need for an up-to-date cost-effectiveness evaluation of diagnostic algorithms, and more evidence to learn whether there is a low-risk group of women who are unlikely to benefit from treatment of asymptomatic bacteriuria.

Pregnancy following urinary tract reconstruction using bowel segments: a review of published literature.

To provide a literature review of the urological and obstetric outcomes during and after pregnancy following urinary diversion using bowel segments. A systematic literature research by specific keywords was performed in February 2017. Relevant articles were assessed and available parameters such as, e.g., number of included patients, indication for and type of urinary diversion, birth mode and complications during and after pregnancy were evaluated. We found 61 relevant articles published between 1961 and 2017. Overall, data of 282 females carrying 330 babies within 395 pregnancies were listed. Birth was via vaginal delivery in 132 cases, while 183 females delivered via elective or emergency cesarean. The main urological complications during pregnancy were urinary tract infections, pyelonephritis and dilatation of the upper urinary tract. In total, 155 episodes of pyelonephritis (39.2%) were reported, but no major or persisting complications occurred. After urinary diversion, pregnancy is possible without major complications. Due to an increased risk of pyelonephritis and dilatation of the upper urinary tract requiring intervention, these pregnancies should be considered high risk. Vaginal delivery as well as delivery by cesarean is feasible, but should be carried out in centers of expertise with urological stand-by.