Pyuria, bacteriuria and empirical antibiotic selection in pregnant women

Year 2024, , 361 - 365, 30.07.2024

Ayşegül Tuna , İlknur Akkuş , Serdar Gül , Birgül Kaçmaz

https://doi.org/10.32322/jhsm.1473012

Abstract

Aims: In pregnancy, early diagnosis and proper treatment of urinary tract infections are crucial in preventing maternal and fetal comorbidities. Therefore, pregnant women should be screened for asymptomatic bacteriuria. This study aimed to evaluate the relationship between pyuria and bacteriuria and the susceptibility of uropathogens, as well as to review the empiric drug options for pregnant women.
Methods: The presence of pyuria and bacteriuria in urine samples obtained from the pregnant outpatient clinic between January 2023 and December 2023 at Kırıkkale University Faculty of Medicine Hospital’s Infectious Diseases and Clinical Microbiology Laboratory was investigated. Uropathogens were identified and typed using the BD Phoenix™ M50 automated system for bacterial identification and antibiotic susceptibility testing, and antibiotic susceptibility was interpreted according to the European Committee on Antimicrobial Susceptibility Testing criteria.
Results: A total of 1457 urine samples were evaluated in this retrospective study. Uropathogens were detected in 235 patients, while 301 samples were considered contaminated. Uropathogens were found to be susceptible to amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin, in that order, for use in pregnant women. High resistance rates to third-generation cephalosporins were observed.
Conclusion: According to the results of this study, local resistance rates against urinary pathogens in pregnant women should be determined at specific intervals, and empirical antibiotic therapy should be planned based on these data.

Keywords

Asymptomatic bacteriuria, urinary tract infection, empirical antibiotherapy

References

• Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am. 1997;11(3):593-608. doi:10.1016/s0891-5520(05)70375-5
• Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83-e110. doi:10.1093/cid/ciy1121
• Golan A, Wexler S, Amit A, Gordon D, David MP. Asymptomatic bacteriuria in normal and high-risk pregnancy. Eur J Obstet Gynecol Reprod Biol. 1989;33(2):101-108. doi:10.1016/0028-2243 (89)90202-5
• Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014;210(3):219.e1-219.e2196. doi:10.1016/j.ajog.2013.10.006
• Moore A, Doull M, Grad R, et al. Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ. 2018;190(27): E823-E830. doi:10.1503/cmaj.171325
• Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol. 1989;73(4):576-582.
• Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005;105(1):18-23. doi:10.1097/01.AOG.0000149154.96285.a0
• Archabald KL, Friedman A, Raker CA, Anderson BL. Impact of trimester on morbidity of acute pyelonephritis in pregnancy. Am J Obstet Gynecol. 2009;201(4):406.e1-406.e4064. doi:10.1016/j.ajog.2009.06.067
• Sweet RL. Bacteriuria and pyelonephritis during pregnancy. Semin Perinatol. 1977;1(1):25-40.
• Petersson C, Hedges S, Stenqvist K, Sandberg T, Connell H, Svanborg C. Suppressed antibody and interleukin-6 responses to acute pyelonephritis in pregnancy. Kidney Int. 1994;45(2):571-577. doi:10.1038/ki.1994.74
• Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83-e110. doi:10.1093/cid/ciy1121
• Graseck AS, Thompson JL, Bryant AS, Cahill AG, Silverman NS, Turrentine MA. Urinary tract infections in pregnant individuals. Obstet Gynecol. 2023;142(2):435-445. doi:10.1097/AOG.0000000000005269
• Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2019;2019(11): CD000490. doi:10.1002/14651858.CD000490.pub4
• Sobel JD, Brown P. Urinary tract infections. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, ninth edition. Bennett JE, Dolin R, BlaserMJ (eds). Philadelphia. 2020:962-989.
• Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis. 1992;15 Suppl 1:S216-S227. doi:10.1093/clind/15.supplement_1.s216
• Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev. 2015;2015(11):CD000491. doi:10.1002/14651858.CD000491.pub3
• The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 14.0, 2024. http://www.eucast.org.
• Forbes BA, Sahm DF, Weissfeld AS. Infections of the Urinary Tract. In: Bailey & Scott’s Diagnostic Microbiology. 12th ed. Philadelphia: Elsevier. 2007: 842-855.
• Kaye KS, Gupta V, Mulgirigama A, et al. Antimicrobial resistance trends in urine escherichia coli isolates from adult and adolescent females in the United States from 2011 to 2019: rising ESBL strains and impact on patient management. Clin Infect Dis. 2021;73(11):1992-1999. doi:10.1093/cid/ciab560
• Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol. 2019;11: 1756287219832172. doi:10.1177/1756287219832172
• Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1-13. doi:10.1016/j.idc.2013.09.003
• Vazquez JC, Abalos E. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst Rev. 2011; (1):CD002256. doi:10.1002/14651858.CD002256.pub2
• Critchley IA, Cotroneo N, Pucci MJ, Jain A, Mendes RE. Resistance among urinary tract pathogens collected in Europe during 2018. J Glob Antimicrob Resist. 2020;23:439-444.
• Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother. 2012;56(4):2181-20183. doi:10.1128/AAC.06060-11
• Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States 2019. Published November 13, 2019. Accessed April 5, 2024. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
• Frazee BW, Trivedi T, Montgomery M, Petrovic DF, Yamaji R, Riley L. Emergency department urinary tract infections caused by extended-spectrum β-lactamase-producing enterobacteriaceae: many patients have no identifiable risk factor and discordant empiric therapy is common. Ann Emerg Med. 2018;72(4):449-456. doi:10.1016/j.annemergmed.2018.05.006
• Simmering JE, Tang F, Cavanaugh JE, Polgreen LA, Polgreen PM. The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998-2011. Open Forum Infect Dis. 2017;4(1):ofw281. doi:10.1093/ofid/ofw281
• Bookstaver PB, Bland CM, Griffin B, Stover KR, Eiland LS, McLaughlin M. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015;35(11):1052-1062. doi:10.1002/phar.1649
• Committee Opinion No. 717: Sulfonamides, Nitrofurantoin, and Risk of Birth Defects. Obstet Gynecol. 2017;130(3):e150-e152. doi:10.1097/AOG.0000000000002300
• Macrobid - Nitrofurantoin Monohydrate and Nitrofurantoin, Macrocrystalline Capsule. US Food and Drug Administration (FDA) Approved Product Information. Updated March 2009. Accessed April 12, 2023. https://dailymed.nlm.nih.gov/
• Graseck AS, Thompson JL, Bryant AS, Cahill AG, Silverman NS, Turrentine MA. Urinary tract infections in pregnant individuals. Obstet and Gynecol, 2023;142(2),435-445.
• Kaçmaz B, Gül S, Ayaşlıoğlu E, et al. İdrarda piyüri ve kültür sonuçlarının karşılaştırılması. Kırıkkale Uni Med J. April. 2016; 18(1):19-22. doi:10.24938/kutfd.252667
• Sobel JD, Kaye D. Urinary tract infections. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th Edition. 2015:886-913.
• Macejko AM, Schaeffer AJ. Asymptomatic bacteriuria and symptomatic urinary tract infections during pregnancy. Urol Clin North Am. 2007;34(1):35-42. doi:10.1016/j.ucl.2006.10.010
• Schneeberger C, van den Heuvel ER, Erwich JJHM, Stolk RP, Visser CE, Geerlings SE. Contamination rates of three urine-sampling methods to assess bacteriuria in pregnant women. Obstet Gynecol. 2013;121(2 Pt 1):299-305. doi:10.1097/AOG.0b013e31827e8cfe
• Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev. 2015;2015(11):CD000491. doi:10.1002/14651858.CD000491.pub3
• Wang T, Wu G, Wang J, et al. Comparison of single-dose fosfomycin tromethamine and other antibiotics for lower uncomplicated urinary tract infection in women and asymptomatic bacteriuria in pregnant women: a systematic review and meta-analysis. Int J Antimicrob Agents. 2020;56(1): 106018. doi:10.1016/j.ijantimicag.2020.106018
• Langermans LM, Cools W, Van Limbergen I, Gucciardo L, Faron G. Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester. J Perinat Med. 2021;49(5):539-545. doi:10.1515/jpm-2020-0322