Urinary Tract Infections in Pregnant Individuals

DiGirolamo, Gregory J.; González, Gerardo; Smelson, David A.; Guevremont, Nathan; Andre, Michael I.; Patnaik, Pooja; Zaniewski, Zachary R.

doi:10.1097/aog.0000000000005269

Cited by 11 publications

(2 citation statements)

References 58 publications

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“…The use of fluoroquinolones and trimethoprim-sulfamethoxazole is generally discouraged in pregnancy [30]. The guideline endorsed by the American College of Obstetricians and Gynecologists should be considered for treatment approach in this particular patient population [31]. Lastly, the proposed recommendations presented are for the clinical diagnosis of APN only, and are not appropriate for the management of UTIs with complicating factors such as urinary tract obstruction.…”

Section: Limitationsmentioning

confidence: 99%

Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis

Pizzuti,

Tsai,

Winders

et al. 2023

Pharmacy

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Acute pyelonephritis (APN) is a relatively common community-acquired infection, particularly in women. The early appropriate antibiotic treatment of this potentially life-threatening infection is associated with improved outcomes. The international management guidelines for complicated urinary tract infections and APN recommend using oral antibiotics with <10% resistance among urinary pathogens. However, increasing antibiotic resistance rates among Escherichia coli and other Enterobacterales to fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), and beta-lactams has left patients without reliable oral antibiotic treatment options for APN. This narrative review proposes using precision medicine concepts to improve empirical antibiotic therapy for APN in ambulatory settings. Whereas resistance rates to a particular antibiotic class may exceed 10% at the population-based level, the predicted antibiotic resistance rates based on patient-specific risk factors fall under 10% in many patients with APN on the individual level. The utilization of clinical tools for the prediction of fluoroquinolones, TMP-SMX, and third-generation cephalosporin resistance improves the ambulatory antibiotic management of APN. It may also reduce the need to switch antibiotic therapy later based on the in vitro antibiotic susceptibility testing results of bacterial isolates in urinary cultures. This approach may mitigate the burden of increasing antibiotic resistance in the community by ensuring that the initial antibiotic prescribed has the highest likelihood of treating APN appropriately.

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Section: Limitationsmentioning

confidence: 99%

Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis

Pizzuti,

Tsai,

Winders

et al. 2023

Pharmacy

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“…Studies have shown that women with a UTI, particularly those requiring an emergency department visit or hospitalization, face an increased risk of preterm and early term births [ 4 , 5 ]. This is a critical concern, as UTIs are one of the more common perinatal complications, affecting approximately 8% of pregnancies and representing a spectrum from asymptomatic bacteriuria to more severe infections like pyelonephritis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births

Bratosin,

Folescu,

Krupyshev

et al. 2024

Microorganisms

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The rise of multidrug-resistant organisms has significantly complicated the clinical management of urinary tract infections (UTIs), particularly in the context of pregnancy. This study aimed to identify and analyze the significant differences in microbial species and multidrug resistance patterns associated with UTIs in preterm versus full-term births, determine the bacterial species significantly associated with preterm birth, and describe the antibiotic resistance patterns affecting pregnant women with UTIs. This case–control study was conducted in western Romania and focused on pregnant women with UTIs admitted from 2019 to 2023. Data were retrospectively collected from 308 patients with positive cultures. Statistical analyses, including the Chi-square test, Fisher’s exact test, and logistic regression models, were employed to compare the proportions of microbial species and resistance patterns between preterm (n = 126) and full-term (n = 182) birth groups and identify factors independently associated with preterm birth. The study found no significant differences in demographic or lifestyle factors between the groups. However, significant differences were observed in several infection and inflammation markers. The median white blood cell count was higher in the preterm group (12.3 vs. 9.1, p = 0.032), and the median C-reactive protein level was significantly higher in the preterm group (18 vs. 7, p < 0.001). The preterm group exhibited a higher incidence of multidrug-resistant organisms, notably ESBL-producing organisms (19.8% vs. 4.4%, p < 0.001) and carbapenem-resistant Enterobacteriaceae (4.8% with p = 0.003). Notably, the resistance to amoxicillin was significantly higher in the preterm group (20.6% vs. 6.6%, p < 0.001). Significant bacterial associations with preterm births included Group B Streptococcus (OR 2.5, p = 0.001) and Enterobacter spp. (OR 1.8, p = 0.022). The study confirmed significant differences in microbial species and multidrug resistance patterns between UTIs associated with preterm and full-term births. The higher prevalence of certain bacteria and increased resistance to commonly used antibiotics in the preterm group underscore the need for tailored antimicrobial therapies and robust microbial identification in managing UTIs during pregnancy.

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Association of common maternal infections with birth outcomes: a multinational cohort study

He,

Tikellis,

Paltiel

et al. 2024

Infection

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Urinary Tract Infections in Pregnant Individuals

Cited by 11 publications

References 58 publications

Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis

Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births

Association of common maternal infections with birth outcomes: a multinational cohort study

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