Is asymptomatic bacteriuria associated with short cervical length in women with a singleton pregnancy, a secondary analysis of two national cohort studies with small embedded randomized controlled trials

Koningstein, Fiona N.; Schneeberger, Caroline; Ven, A. J. van der; Os, M. A. van; Pajkrt, Eva; Groot, Christianne de; Mol, Ben W.; Geerlings, Susanne E.; Kazemier, Brenda M.

doi:10.1016/j.ejogrb.2020.03.015

Cited by 1 publication

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“…If not managed properly, APN can trigger septic shock manifested by hemodynamic instability, low blood pressure, and more complications. Some scholars pointed out that presepsin (PSEP) and PCT were independent predictors of septic shock following APN with concomitant kidney stones [ 17 ]. Meanwhile, a study pointed out that application of quick Sequential Organ…”

Section: Discussionmentioning

confidence: 99%

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Stents in a Pregnant Woman: A Case Report and Literature Review

2022

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Patient: Female, 26-year-old Final Diagnosis: Acute pyelonephritis • kidney stones • hydronephrosis Symptoms: Bacteriuria • lumbar pain • septic shock Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Bacteriuria occurs in many pregnant women which may result in symptomatic urinary tract infection (UTI), including acute pyelonephritis (APN), which can lead to septic shock. However, there was no standard protocol of managing pregnant women with APN about the regimen, timing, length of antibiotic appliance as well as the indication of implanting double-J ureteral stents in those with kidney stones. Case Report: A 26-year-old pregnant woman (G1P0, 27 weeks plus 3 days) presented to our hospital on account of fever and pain in the flanks and was admitted on account of suspected UTI due to bacteriuria and elevated inflammatory markers. Elevated WBC count of 18.26×10 9 /L, PCT of 2.75, CRP of 198 mg/L, existence of kidney stones, renal and perirenal inflammation were observed. Cefoperazone sodium sulbactam sodium was given. The patient experienced septic shock on day 2 with a low blood pressure of 81/52 mmHg. Double-J ureteral stents were implanted due to upper urinary tract obstruction on day 3 with continuous use of meropenem based on urine culture and antibiotic sensitivity results. From day 7, the antibiotics were changed to cefoperazone-sulbactam. The patient’s laboratory results (biochemistry, PCT, and CRP) all gradually went to normal, and she was discharged on day 15. Conclusions: We learned that urine culture and antibiotic sensitivity examination were suggested after bacteriuria was observed in pregnant women to guide further treatment. Once APN was suspected, antibiotic therapy should be commenced and early-stage drainage by double-J ureteral stents could be considered if warranted in appropriate patients.

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Section: Discussionmentioning

confidence: 99%