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

Denoble, Annalies; Reid, Hadley; Krischak, Madison; Rosett, Heather; Sachdeva, Sarika; Weaver, Kristin; Heine, R. Phillips; Dotters‐Katz, Sarah K.

doi:10.1016/j.ajogmf.2021.100540

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Patients not showing clinical improvement within 72 hours should be further evaluated to ensure bacterial resistance is not present and undergo imaging to rule out other urinary tract pathology (8,10). Antimicrobial resistance is the most common reason for treatment failure (1,8,9,11,54). After clinical improvement, patients should be transitioned to appropriate oral antibiotics based on culture sensitivity to complete a 14-day course of therapy (8,39).…”

Section: Treatmentmentioning

confidence: 99%

“…These infections represent a spectrum, from asymptomatic bacteriuria (ASB), to symptomatic acute cystitis, to the most serious, pyelonephritis. Overall, Escherichia coli is the most common bacterial pathogen isolated in urine samples from pregnant individuals (6–9). The presence of UTIs has been associated with adverse pregnancy outcomes, including increased rates of preterm delivery and low birth weight.…”

Section: Introductionmentioning

confidence: 99%

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Urinary Tract Infections in Pregnant Individuals

2023

Obstetrics &Amp; Gynecology

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SUMMARY Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies (1, 2). These infections represent a spectrum, from asymptomatic bacteriuria, to symptomatic acute cystitis, to the most serious, pyelonephritis. The presence of UTIs has been associated with adverse pregnancy outcomes, including increased rates of preterm delivery and low birth weight. Screening for and treating asymptomatic bacteriuria have been shown in multiple studies to reduce the incidence of pyelonephritis in pregnancy (3–5). Given the frequency at which UTIs are encountered in pregnancy, the ability to recognize, diagnose, and treat them is essential for those providing care to pregnant individuals. This Clinical Consensus document was developed using an established protocol in conjunction with the authors listed.

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Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Urinary Tract Infections in Pregnant Individuals

2023

Obstetrics &Amp; Gynecology

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“…Other frequent bacteria include Klebsiella , Enterobacter , Citrobacter , Proteus , Pseudomonas , group B Streptococcus (GBS), and Enterococcus spp. ( Rac et al, 2019 ; Denoble et al, 2021 ). GBS ( Streptococcus agalactiae ) is present in 2–10% of all asymptomatic bacteriuria and has been associated with significantly elevated rates of premature rupture of membranes, preterm labor, and neonatal infection ( Matuszkiewicz-Rowinska et al, 2015 ; Szweda and Jozwik 2016 ; Abou Heidar et al, 2019 ).…”

Section: Conventional Treatment Of Urinary Tract Infections In Pregna...mentioning

confidence: 99%

“…Third-generation cephalosporins (e.g., ceftriaxone) may be recommended. When urine culture is available, first-generation cephalosporins and penicillins (e.g., ampicillin and ampicillin-sulbactam) may be recommended ( Denoble et al, 2021 ). For severe pyelonephritis cases, carbapenems may be prescribed.…”

Section: Conventional Treatment Of Urinary Tract Infections In Pregna...mentioning

confidence: 99%

“…Clindamycin and erythromycin can be used in women allergic to penicillin; however, over 40% of GBS infections are resistant to clindamycin, and over 50% are resistant to erythromycin ( CDC, 2019 ). A recent retrospective cohort study of 334 women with gram-negative bacteriuria found that antibiotic-resistant organisms were most often (>50%) responsible for bacteriuria in pregnant women; these women were 2–3x as likely to develop pyelonephritis ( Denoble et al, 2021 ).…”

Section: Conventional Treatment Of Urinary Tract Infections In Pregna...mentioning

confidence: 99%

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Examination of Complementary Medicine for Treating Urinary Tract Infections Among Pregnant Women and Children

et al. 2022

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Urinary tract infections (UTIs) are a significant clinical problem that pregnant women and children commonly experience. Escherichia coli is the primary causative organism, along with several other gram-negative and gram-positive bacteria. Antimicrobial drugs are commonly prescribed to treat UTIs in these patients. Conventional treatment can range from using broad-spectrum antimicrobial drugs for empirical or prophylactic therapy or patient-tailored therapy based on urinary cultures and sensitivity to prospective antibiotics. The ongoing emergence of multi-drug resistant pathogens has raised concerns related to commonly prescribed antimicrobial drugs such as those used routinely to treat UTIs. Consequently, several natural medicines have been explored as potential complementary therapies to improve health outcomes in patients with UTIs. This review discusses the effectiveness of commonly used natural products such as cranberry juice/extracts, ascorbic acid, hyaluronic acid, probiotics, and multi-component formulations intended to treat and prevent UTIs. The combination of natural products with prescribed antimicrobial treatments and use of formulations that contained high amounts of cranberry extracts appear to be most effective in preventing recurrent UTIs (RUTIs). The incorporation of natural products like cranberry, hyaluronic acid, ascorbic acid, probiotics, Canephron® N, and Cystenium II to conventional treatments of acute UTIs or as a prophylactic regimen for treatment RUTIs can benefit both pregnant women and children. Limited information is available on the safety of natural products in these patients’ populations. However, based on limited historical information, these remedies appear to be safe and well-tolerated by patients.

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