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Hari P, Meena J, Kumar M, Sinha A, Thergaonkar RW, Iyengar A, Khandelwal P, Ekambaram S, Pais P, Sharma J, Kanitkar M, Bagga A. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatr Nephrol 2024; 39:1639-1668. [PMID: 37897526 DOI: 10.1007/s00467-023-06173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/27/2023] [Accepted: 09/17/2023] [Indexed: 10/30/2023]
Abstract
We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.
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Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jitendra Meena
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manish Kumar
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Arpana Iyengar
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sudha Ekambaram
- Department of Pediatric Nephrology, Apollo Children's Hospital, Chennai, India
| | - Priya Pais
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Jyoti Sharma
- Department of Pediatrics, KEM Hospital, Pune, India
| | | | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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de Souza HD, Diório GRM, Peres SV, Francisco RPV, Galletta MAK. Bacterial profile and prevalence of urinary tract infections in pregnant women in Latin America: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:774. [PMID: 37940852 PMCID: PMC10631168 DOI: 10.1186/s12884-023-06060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Given the physiological changes during pregnancy, pregnant women are likely to develop recurrent urinary tract infections (UTIs) and pyelonephritis, which may result in adverse obstetric outcomes, including prematurity and low birth weight preeclampsia. However, data on UTI prevalence and bacterial profile in Latin American pregnant women remain scarce, necessitating the present systematic review to address this issue. METHODS To identify eligible observational studies published up to September 2022, keywords were systematically searched in Medline/PubMed, Cochrane Library, Embase, Web of Science, and Bireme/Lilacs electronic databases and Google Scholar. The systematic review with meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of studies was classified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The meta-analysis employed a random-effects method with double-arcsine transformation in the R software. RESULTS Database and manual searches identified 253,550 citations published until September 2022. Among the identified citations, 67 met the inclusion criteria and were included in the systematic review, corresponding to a sample of 111,249 pregnant women from nine Latin American countries. Among Latin American pregnant women, the prevalence rates of asymptomatic bacteriuria, lower UTI, and pyelonephritis were estimated at 18.45% (95% confidence interval [CI]: 15.45-21.53), 7.54% (95% CI: 4.76-10.87), and 2.34% (95% CI: 0.68-4.85), respectively. Some regional differences were also detected. Among the included studies, Escherichia coli (70%) was identified as the most frequently isolated bacterial species, followed by Klebsiella sp. (6.8%). CONCLUSION Pregnant women in Latin America exhibit a higher prevalence of bacteriuria, UTI, and pyelonephritis than pregnant women globally. This scenario reinforces the importance of universal screening with urine culture during early prenatal care to ensure improved outcomes. Future investigations should assess the microbial susceptibility profiles of uropathogens isolated from pregnant women in Latin America. TRIAL REGISTRATION This research was registered at PROSPERO (No. CRD42020212601).
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Affiliation(s)
- Henrique Diório de Souza
- Disciplina de Obstetricia, Departamento de Obstetricia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 155 - 10º Andar - Sala 10.037. CEP, São Paulo, BR, 05403-000, Brazil
- Department of Maternal and Child Health, Medical School of the Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Stela Verzinhasse Peres
- Disciplina de Obstetricia, Departamento de Obstetricia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 155 - 10º Andar - Sala 10.037. CEP, São Paulo, BR, 05403-000, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 155 - 10º Andar - Sala 10.037. CEP, São Paulo, BR, 05403-000, Brazil
| | - Marco Aurélio Knippel Galletta
- Disciplina de Obstetricia, Departamento de Obstetricia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 155 - 10º Andar - Sala 10.037. CEP, São Paulo, BR, 05403-000, Brazil.
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Khapre M, Sharma D, Mehta A, Sinha S. Prevalence of Asymptomatic Bacteriuria (ASB) in Pregnant Women in India: A Systematic Review and Meta-Analysis. Indian J Community Med 2023; 48:879-887. [PMID: 38249695 PMCID: PMC10795867 DOI: 10.4103/ijcm.ijcm_795_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/01/2023] [Indexed: 01/23/2024] Open
Abstract
Background Asymptomatic bacteriuria is prevalent during pregnancy. If it goes undetected, it can lead to urinary tract infection with severe maternal and neonatal complications. Until date, India does not have any guidelines to test for ASB during pregnancy. Objective To estimate the pooled prevalence of asymptomatic bacteriuria in pregnant women at national level in India. Material and Methods We searched Medline, Embase, Web of Science, and Google Scholar using search strategy with keyword. Two authors independently assessed the eligibility of study. The checklist of the JBI was used for evaluating the quality of reporting. The extracted data were analyzed, and the results were reported using a random-effects model with 95% confidence interval (CI). Subgroup analysis was conducted for zones of India, parity and trimester. Publication bias is reported as funnel plot. Result Pooled prevalence of asymptomatic bacteriuria among pregnant women in India is 13.5% [CI 11.1; 15.8]. Subgroup analysis based on the various geographic zones of the country the pooled prevalence ranged from 9.2% in central zone to 14.8% in south zone. Distribution of prevalence of ASB as per parity was approximately identical. The prevalence of ASB was found to be high in third (21.8%). Conclusion The prevalence of ASB is found to be high among Indian pregnant women, especially in third trimester. It is therefore recommended for guideline to screen and treat every pregnant woman for ASB to prevent further complications.
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Affiliation(s)
- Meenakshi Khapre
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Divita Sharma
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Aprajita Mehta
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Smita Sinha
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
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Abstract
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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Wang L, Yan XY, Mei L, Jia ZW, Hao RG, Xu JH, Zhang B. Effect of e-health interventions on HIV prevention: a protocol of systematic review and meta-analysis. Syst Rev 2023; 12:106. [PMID: 37391806 PMCID: PMC10311723 DOI: 10.1186/s13643-023-02274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Global epidemiological data indicates that despite implementation of multiple interventions and significant financial investment, the HIV/AIDS epidemic remained inadequately controlled as of 2020. E-health presents a novel approach in delivering health information and health care and has gained popularity in HIV prevention worldwide. However, evidence on the effectiveness of e-health interventions on HIV prevention among diverse populations remains inadequate. Our study aims to systematically evaluate the effectiveness of varying e-health interventions on HIV prevention, with the objective of providing data support and guidance for the development of future e-health HIV intervention strategies. METHODS A systematic search of electronic English databases, including MEDLINE through PubMed, Embase, Scopus, and Web of Science, along with three Chinese databases, including National Knowledge Infrastructure (CNKI), Chinese Wanfang Digital Periodicals (WANFANG), and Chinese Science and Technology Periodicals (VIP) database, will be conducted for the period of 1 January 1980 to 31 December 2022. Additionally, gray literature and unpublished trials in trial registers will be searched. Studies aimed at HIV prevention through e-health interventions, with full-text publications available in either English or Chinese, will be included. Study types will be limited to RCT, cluster RCT, and quasi-experiment study. The risk of bias in individual studies will be assessed following the guideline highlighted by the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes will cover cognitive, behavioral, psychological, management, and biological measures of individuals involved in e-health interventions. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Ultimately, a systematic review with meta-analysis will be conducted to compare the effectiveness of e-health interventions among diverse populations. DISCUSSION This systematic review seeks to establish novel insights into the effectiveness of e-health interventions in diverse populations worldwide. It will inform the design and use of e-health interventions to optimize HIV-related strategies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022295909.
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Affiliation(s)
- Lei Wang
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
- School of Public Health, Peking University, Beijing, China
| | - Xiang-Yu Yan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Lin Mei
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Zhong-Wei Jia
- School of Public Health, Peking University, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
- Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
| | - Rui-Gang Hao
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Ji-Hong Xu
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Bo Zhang
- School of Life Sciences, Hainan University, Haikou, 570228, China.
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Vicar EK, Acquah SEK, Wallana W, Kuugbee ED, Osbutey EK, Aidoo A, Acheampong E, Mensah GI. Urinary Tract Infection and Associated Factors among Pregnant Women Receiving Antenatal Care at a Primary Health Care Facility in the Northern Region of Ghana. Int J Microbiol 2023; 2023:3727265. [PMID: 37303774 PMCID: PMC10256441 DOI: 10.1155/2023/3727265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Urinary tract infection (UTI) is frequently encountered during pregnancy and is associated with adverse maternal, fetal, and neonatal effects. However, very little information is available on the prevalence of UTI among pregnant women in the northern part of Ghana, a region with a high birth rate. This study employed a cross-sectional analysis of the prevalence, antimicrobial profile, and risk factors associated with UTI in 560 pregnant women attending primary care for antenatal check-ups. Sociodemographic obstetrical history and personal hygiene information were obtained using a well-structured questionnaire. Afterward, clean catch mid-stream urine samples were collected from all participants and subjected to routine microscopy examination and culture. Of 560 pregnant women, 223 cases (39.8%) were positive for UTI. There was a statistically significant association between sociodemographic, obstetric, and personal hygiene variables and UTI (p < 0.0001). Escherichia coli (27.8%) was the commonest bacterial isolate followed by CoNS (13.5%) and Proteus species (12.6%). These isolates exhibited greater resistance to ampicillin (70.1-97.3%) and cotrimoxazole (48.1-89.7%) but were fairly susceptible to gentamycin and ciprofloxacin. Gram-negative resistance to meropenem was up to 25.0%, and Gram positives resistance to cefoxitin and vancomycin was up to 33.3% and 71.4% respectively. The current findings extend our knowledge of the high frequency of UTIs and associated risk factors in pregnant women with E. Coli being the predominant and usual isolate. Variation existed in the resistance pattern of isolates to various drugs, underscoring the need to perform urine culture and susceptibility before treatment.
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Affiliation(s)
- Ezekiel K. Vicar
- Department of Clinical Microbiology, School of Medicine, University for Development Studies, Tamale, Northern Region, Ghana
| | - Samuel E. K. Acquah
- Department of Infectious Diseases, School of Allied Health Science, University for Development Studies, Tamale, Northern Region, Ghana
| | - Williams Wallana
- Department of Clinical Microbiology, School of Medicine, University for Development Studies, Tamale, Northern Region, Ghana
| | - Eugene D. Kuugbee
- School of Medical Sciences, C. K. Tedam University of Science and Technology, Navrongo, Upper East. Region, Ghana
| | - Emmanuel K. Osbutey
- Department of Anatomy, School of Medicine, University for Development Studies, Tamale, Northern Region, Ghana
| | - Abigail Aidoo
- Department of Midwifery and Women's Health, School of Nursing and Midwifer, University for Development Studies, Tamale, Northern Region, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Health and Medical Sciences, Edith Cowan University, Joondalup, Australia
| | - Gloria Ivy Mensah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon Greater Accra Region, Accra, Ghana
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Kumar L, Dwivedi M, Jain N, Shete P, Solanki S, Gupta R, Jain A. The Female Reproductive Tract Microbiota: Friends and Foe. Life (Basel) 2023; 13:1313. [PMID: 37374096 DOI: 10.3390/life13061313] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
We do not seem to be the only owner of our body; it houses a large population of microorganisms. Through countless years of coevolution, microbes and hosts have developed complex relationships. In the past few years, the impact of microbial communities on their host has received significant attention. Advanced molecular sequencing techniques have revealed a remarkable diversity of the organ-specific microbiota populations, including in the reproductive tract. Currently, the goal of researchers has shifted to generate and perceive the molecular data of those hidden travelers of our body and harness them for the betterment of human health. Recently, microbial communities of the lower and upper reproductive tract and their correlation with the implication in reproductive health and disease have been extensively studied. Many intrinsic and extrinsic factors influences the female reproductive tract microbiota (FRTM) that directly affects the reproductive health. It is now believed that FRTM dominated by Lactobacilli may play an essential role in obstetric health beyond the woman's intimate comfort and well-being. Women with altered microbiota may face numerous health-related issues. Altered microbiota can be manipulated and restored to their original shape to re-establish normal reproductive health. The aim of the present review is to summarize the FRTM functional aspects that influence reproductive health.
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Affiliation(s)
- Lokesh Kumar
- Genus Breeding India Pvt Ltd., Pune 411005, Maharashtra, India
| | - Monika Dwivedi
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra 835215, Jharkhand, India
| | - Natasha Jain
- Department of Biotechnology, Chaudhary Charan Singh University, Meerut 250001, Uttar Pradesh, India
| | - Pranali Shete
- Department of Microbiology, Smt. CHM College, University of Mumbai, Ulhasnagar 421003, Maharashtra, India
| | - Subhash Solanki
- Genus Breeding India Pvt Ltd., Pune 411005, Maharashtra, India
| | - Rahul Gupta
- Genus Breeding India Pvt Ltd., Pune 411005, Maharashtra, India
| | - Ashish Jain
- Department of Microbiology, Smt. CHM College, University of Mumbai, Ulhasnagar 421003, Maharashtra, India
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Haque Sumon AHMS, Al-Mahmood MR, Islam KA, Karim ANME, Aker P, Ullah A, Rashid MA, Hasan MN. Multidrug Resistance Urinary Tract Infection in Chronic Kidney Disease Patients: An Observational Study. Cureus 2023; 15:e38571. [PMID: 37284390 PMCID: PMC10239557 DOI: 10.7759/cureus.38571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To determine the presence of multidrug-resistant (MDR) urinary tract infections (UTI) and the MDR pattern of the bacterial isolates causing MDR UTI in chronic kidney disease (CKD) patients. METHODS This cross-sectional study was conducted among 326 diagnosed CKD patients in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU). Purposive sampling technique was used, and data were collected from the respondents using a semi-structured questionnaire. From duly collected urine samples, identification of organisms and antibiotic susceptibility tests were done, maintaining proper procedure in the microbiology laboratory. RESULTS The study population was predominantly female (60.1%). The outpatient department provided the majority of the respondents (75.2%). A history of UTI within the last six months was present among 74.2% of the respondents, and 59.2% had a history of taking antibiotics. Bacterial isolates were predominantly gram-negative (79.4%). Escherichia coli was the most prevalent bacterial isolate, present in 55.5% of the study population. Among the respondents, 64.7% were found to have MDR UTI, and among them, 81.5% were gram-negative, and 18.5% were gram-positive isolates. Among all the antibiotics tested, Colistin Sulphate, Polymyxin B, Cefoxitin, Vancomycin, and Linezolid had the highest (100%) sensitivity, followed by Meropenem, with 94.9% sensitivity. Among the gram-negative isolates, Acinetobacter and Enterobacter were most resistant to aminoglycoside, at 70% and 91.7%, respectively. E. coli, Klebsiella, Proteus, and Pseudomonas were most resistant to quinolone at 76.8%, 76.9%, 83.3%, and 66.7%, respectively. Among the gram-positive isolates, Enterococci and Staphylococcus aureus were most resistant to aminoglycoside, 81.5% and 88.9%, respectively. Streptococcus was found to be most resistant to cephalosporin (75.0%). There was a statistically significant (p < 0.05) relationship between MDR UTI, history of UTI, and previous antibiotic intake, and diabetic CKD. CONCLUSIONS The prevalence of MDR UTI among CKD patients is considerably high. When treating UTI, choosing an appropriate antibiotic by urine culture and implementing a guideline on the rational use of antibiotics are essential to managing and preventing the development of MDR UTI.
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Affiliation(s)
| | - Md Rashid Al-Mahmood
- Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
- Physical Medicine and Rehabilitation, Northern International Medical College, Dhaka, BGD
| | | | | | - Parvin Aker
- Biochemistry, Shaheed Ziaur Rahman Medical College Hospital, Bogura, BGD
| | - Ahsan Ullah
- Internal Medicine, Titas Upazila Health Complex, Cumilla, BGD
| | | | - Md Nazmul Hasan
- Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
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Barry R, Houlihan E, Knowles SJ, Eogan M, Drew RJ. Antenatal pyelonephritis: a three-year retrospective cohort study of two Irish maternity centres. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04609-6. [PMID: 37126130 DOI: 10.1007/s10096-023-04609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Pyelonephritis affects 1-2% of pregnant women, and is associated with significant maternal and fetal morbidity. Antenatal pyelonephritis has been associated with PPROM (preterm premature rupture of membranes), preterm labour, low birth weight (LBW) and prematurity. A three-year retrospective dual-centre cohort study of antenatal pyelonephritis cases was conducted in two neighbouring Irish maternity hospitals - the Rotunda Hospital (RH) and the National Maternity Hospital (NMH). Patient demographics, clinical presentation, investigations, management and maternal/neonatal outcomes were recorded. A total of 47,676 deliveries (24,768 RH; 22,908 NMH) were assessed. 158 cases of antenatal pyelonephritis were identified (n = 88 RH, n = 70 NMH), with an incidence of 0.33%. The median age was 28 years. The median gestation was 27 + 6 weeks, with 51% presenting before 28 weeks' gestation. Risk factors included; obesity (18.4%), diabetes mellitus (13.3%) and self-reported clinical history of recurrent urinary tract infection (28.5%). Rate of relapse with UTI in the same pregnancy was 8.2%. Renal ultrasound was performed in 30.4%. Predominant uropathogens were Escherichia coli (60%), Klebsiella pneumoniae (11%) and Proteus mirabilis (5%). 7.5% of cases had a concurrent bloodstream infection, 13.3% of cases were complicated by sepsis and 1.9% with septic shock. Complications including PPROM (6.3%), preterm delivery < 37 weeks' gestation (11%), LBW < 2,500 g (8.2%) were comparable between sites. Delivery within 72 hours of diagnosis was noted in 7% (n = 11) of patients, of which three were preterm and one had LBW. Appropriate and prompt investigation and management of antenatal pyelonephritis is essential given the associated maternal and neonatal morbidity.
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Affiliation(s)
- Rachel Barry
- Department of Clinical Microbiology, Rotunda Hospital, Dublin, Ireland.
| | - Elaine Houlihan
- Department of Clinical Microbiology, National Maternity Hospital, Dublin, Ireland
| | - Susan J Knowles
- Department of Clinical Microbiology, National Maternity Hospital, Dublin, Ireland
- Women's and Children's Health, University College Dublin, Dublin, Ireland
| | - Maeve Eogan
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Richard J Drew
- Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Wolfson AR, Schatz MX. Management of the Pregnant Patient with Beta-Lactam Allergy. Curr Allergy Asthma Rep 2023; 23:189-194. [PMID: 36749447 DOI: 10.1007/s11882-023-01069-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW We review the literature and discuss the logistics of testing pregnant patients for penicillin allergy. RECENT FINDINGS As in the general population, pregnant patients commonly report a penicillin allergy, but most patients are able to tolerate penicillin. Avoidance of beta-lactams in pregnancy is associated with increased morbidity: longer hospitalizations, more frequent infections, and more complications. Penicillin allergy testing is safe in pregnant patients, and obstetricians are eager for allergists to offer this procedure to their patients. As allergists, we can improve our patients' health outcomes by offering penicillin allergy testing in our practices. The protocols for testing both with and without skin testing in pregnant patients have been studied, and future studies will continue to clarify the safety and efficacy of penicillin allergy delabeling in pregnant patients.
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Affiliation(s)
- Anna R Wolfson
- Harvard Medical School, Boston, MA, USA. .,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Michael X Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA
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Benevent J, Araujo M, Beau AB, Sicard D, Sommet A, Hurault-Delarue C, Lacroix I, Damase-Michel C. First trimester pregnancy exposure to fosfomycin and risk of major congenital anomaly: a comparative study in the EFEMERIS database. Infection 2023; 51:137-146. [PMID: 35689790 DOI: 10.1007/s15010-022-01861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/21/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Fosfomycin trometamol has been recommended as first-line bactericidal antibiotic for urinary tract infections in pregnant women since 2015 in France. However, studies assessing fosfomycin safety in pregnancy are sparse. This study aimed to assess the risk of major Congenital Anomaly (CA) after fosfomycin exposure during the first trimester of pregnancy. METHODS We performed a comparative study in EFEMERIS, the French database including expecting mothers covered by the French Health Insurance System of Haute-Garonne from July 1st, 2004 to December 31th, 2018. EFEMERIS contains prescribed and dispensed reimbursed medications during pregnancy and pregnancy outcomes. Logistic regressions have been conducted to compare three groups: (1) pregnancies exposed at least once to fosfomycin; (2) pregnancies exposed at least once to nitrofurantoin; and (3) pregnancies exposed neither to fosfomycin nor to nitrofurantoin, another antibiotic prescribed for urinary infections, before and during pregnancy. RESULTS A total of 2724 (2.0%) pregnant women received at least one fosfomycin prescription during the first trimester, 650 (0.5%) received nitrofurantoin during the first trimester, and 133,502 (97.5%) pregnant women were not exposed to fosfomycin nor to nitrofurantoin. First trimester pregnancy exposure to fosfomycin was not associated with an increased risk of major CA, compared to first trimester exposure to nitrofurantoin (2.0% versus 2.5%; ORa = 0.80 [0.44-1.47]), or to pregnancies unexposed to fosfomycin and nitrofurantoin (2.0% versus 2.1%; ORa = 0.97 [0.73-1.30]). CONCLUSION This is the first large comparative study assessing fosfomycin safety in pregnancy. It does not exhibit an increased risk of major CA after fosfomycin exposure during the first trimester of pregnancy.
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Affiliation(s)
- Justine Benevent
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France. .,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France. .,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France.
| | - Mélanie Araujo
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France.,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France
| | - Anna-Belle Beau
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France.,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France
| | - Diane Sicard
- Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France
| | - Agnès Sommet
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France.,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France
| | - Caroline Hurault-Delarue
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France.,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France
| | - Isabelle Lacroix
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France.,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France
| | - Christine Damase-Michel
- Réseau REGARDS, Laboratoire de Pharmacologie Médicale et Clinique, Toulouse University Hospital (CHU de Toulouse), 37 Allées Jules Guesde, 31000, Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France.,CERPOP-SPHERE Team, Université de Toulouse, Inserm UMR 1295, Université Paul Sabatier, Toulouse, France
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12
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Corrales M, Corrales-Acosta E, Corrales-Riveros JG. Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines. J Clin Med 2022; 11:jcm11237226. [PMID: 36498799 PMCID: PMC9740524 DOI: 10.3390/jcm11237226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50-60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use.
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Affiliation(s)
- Mariela Corrales
- Department of Urology AP-HP, Tenon Hospital, F-75020 Paris, France
- Correspondence:
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13
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Werter DE, Kazemier BM, van Leeuwen E, de Rotte MCFJ, Kuil SD, Pajkrt E, Schneeberger C. Diagnostic work-up of urinary tract infections in pregnancy: study protocol of a prospective cohort study. BMJ Open 2022; 12:e063813. [PMID: 36104146 PMCID: PMC9476157 DOI: 10.1136/bmjopen-2022-063813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Symptoms of urinary tract infections in pregnant women are often less specific, in contrast to non-pregnant women where typical clinical symptoms of a urinary tract infection are sufficient to diagnose urinary tract infections. Moreover, symptoms of a urinary tract infection can mimic pregnancy-related symptoms, or symptoms of a threatened preterm birth, such as contractions. In order to diagnose or rule out a urinary tract infection, additional diagnostic testing is required.The diagnostic accuracy of urine dipstick analysis and urine sediment in the diagnosis of urinary tract infections in pregnant women has not been ascertained nor validated. METHODS AND ANALYSIS In this single-centre prospective cohort study, pregnant women (≥16 years old) with a suspected urinary tract infection will be included. The women will be asked to complete a short questionnaire regarding complaints, risk factors for urinary tract infections and baseline characteristics. Their urine will be tested with a urine dipstick, urine sediment and urine culture. The different sensitivities and specificities per test will be assessed. Our aim is to evaluate and compare the diagnostic accuracy of urine dipstick analysis and urine sediment in comparison with urine culture (reference test) in pregnant women. In addition, we will compare these tests to a predefined 'true urinary tract infection', to distinguish between a urinary tract infection and asymptomatic bacteriuria. ETHICS AND DISSEMINATION Approval was requested from the Medical Ethics Review Committee of the Academic Medical Centre; an official approval of this study by the committee was not required. The outcomes of this study will be published in a peer-reviewed journal.
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Affiliation(s)
- Dominique Esmée Werter
- Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, The Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | | | - Sacha D Kuil
- Department of Microbiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Caroline Schneeberger
- Department of Microbiology, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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14
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Prevalence of ESBL Producing Bacteria in Community-Acquired UTI from Eastern Part of India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Urinary tract infection (UTI) in the community is a common infection in humans. The causative microorganisms for UTIs may vary in different places and also vary in their antibiotic sensitivity and resistant patterns. This study aimed to find out the incidence of gram-negative bacteria along with their antibiotic sensitivity pattern in community-acquired UTIs and to calculate the existence of Extended-spectrum beta-lactamase (ESBL) positivity among them. A Sum of 515 urine samples was tested and the causative organisms were identified. Antibiotic susceptibility tests were executed where it had shown growth for bacteria by both manual and automated methods. ESBL tests were performed to identify ESBL-producing isolates. From a total of 515 samples, 65 (12.65%) were culture positive for UTIs. The rate of infection was higher in females than in males. The most prevailing bacteria were Escherichia coli and Klebsiella pneumoniae. Out of total culture-positive isolates, only 43.08% were ESBL positives. The study found that the organisms displayed resistance to Ciprofloxacin and Cefixime and sensitivity to Gentamicin, Ertapenem, and Nitrofurantoin. Females have a higher prevalence of UTIs than males. Mostly, females suffer from UTIs in their reproductive years whereas males suffer in their old age. The prevalence of gram-negative bacteria is higher in community-acquired UTIs. These pathogens though present in the community, becoming resistant to commonly used antibiotics like Ciprofloxacin and Cefixime because of overuse and misuse of antibiotics at the community level.
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15
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Treating urinary tract infections in public sector primary healthcare facilities in Cape Town, South Africa: A pharmaceutical perspective. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Antibiotic resistance is a global healthcare burden complicating the management of infections. Urinary tract infections (UTIs) are commonly treated in primary care. Managing UTIs appropriately in primary care can combat antibiotic resistance. The treatment practices for UTIs in primary care in Western Cape Province, South Africa, are not well described.Objectives. To describe treatment of UTIs in adults in primary care in the Cape Town metropole public sector of the Western Cape. Method. A retrospective multicentre medical records review of patients diagnosed with UTIs was conducted during 1 October 2020 - 28 February 2021. Six public sector primary healthcare facilities were included in the study through random selection from three of the four substructures in the Cape Town metropole. Medical records of adult patients diagnosed with UTIs, through clinical diagnosis or microbiological testing, were identified via a selective sampling process. Data were collected from medical records using a standardised data collection tool.
Results. A total of 401 UTI episodes occurred in 383 patients during the study period. The majority of UTI episodes (84.3%) occurred in females, complicated UTIs (74.1%) were more common than uncomplicated UTIs, and nitrofurantoin (57.1%) was frequently prescribed, followed by ciprofloxacin (39.7%). Compliance with urine microscopy recommendations was low (6.7%), and antibiotics were appropriately selected in 75.0% of uncomplicated and 70.0% of complicated UTI episodes.
Conclusion. Interventions are required to improve compliance with treatment recommendations as per the standard treatment guidelines, especially when selecting the appropriate antibiotic, duration of therapy and urine microscopy.
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16
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Hudson RE, Job KM, Sayre CL, Krepkova LV, Sherwin CM, Enioutina EY. Examination of Complementary Medicine for Treating Urinary Tract Infections Among Pregnant Women and Children. Front Pharmacol 2022; 13:883216. [PMID: 35571128 PMCID: PMC9094615 DOI: 10.3389/fphar.2022.883216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/12/2022] [Indexed: 01/27/2023] Open
Abstract
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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Affiliation(s)
- Rachel E. Hudson
- Department of Pediatrics, Post-Doctoral Fellow, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kathleen M. Job
- Department of Pediatrics, Research Assistant Professor, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Casey L. Sayre
- Department of Pediatrics, Research Assistant Professor, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
- College of Pharmacy, Roseman University of Health Sciences, South Jordan, UT, United States
| | - Lubov V. Krepkova
- Head of Toxicology Department, Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR), Moscow, Russia
| | - Catherine M. Sherwin
- Department of Pediatrics, Vice-Chair for Research, Professor, Wright State University Boonshoft School of Medicine/Dayton Children’s Hospital, Dayton, OH, United States
| | - Elena Y. Enioutina
- Department of Pediatrics, Research Assistant Professor, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
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17
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Jesudason S, Williamson A, Huuskes B, Hewawasam E. Parenthood with kidney failure: Answering questions patients ask about pregnancy. Kidney Int Rep 2022; 7:1477-1492. [PMID: 35812283 PMCID: PMC9263253 DOI: 10.1016/j.ekir.2022.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Achieving parenthood can be an important priority for women and men with kidney failure. In recent decades, the paradigm has shifted toward greater support of parenthood, with advances in our understanding of risks related to pregnancy and improvements in obstetrical and perinatal care. This review, codesigned by people with personal experience of kidney disease, provides guidance for nephrologists on how to answer the questions most asked by patients when planning for parenthood. We focus on important issues that arise in preconception counseling for women receiving dialysis and postkidney transplant. We summarize recent studies reflecting pregnancy outcomes in the modern era of nephrology, obstetrical, and perinatal care in developed countries. We present visual aids to help clinicians and women navigate pregnancy planning and risk assessment. Key principles of pregnancy management are outlined. Finally, we explore outcomes of fatherhood in males with kidney failure.
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18
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Ceulemans M, Foulon V, Panchaud A, Winterfeld U, Pomar L, Lambelet V, Cleary B, O’Shaughnessy F, Passier A, Richardson JL, Nordeng H. Self-Reported Medication Use among Pregnant and Breastfeeding Women during the COVID-19 Pandemic: A Cross-Sectional Study in Five European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031389. [PMID: 35162405 PMCID: PMC8835534 DOI: 10.3390/ijerph19031389] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Insight into the epidemiology of perinatal medication use during the COVID-19 pandemic is scarce. Therefore, a cross-sectional study using an anonymous web survey was performed in Ireland, Norway, Switzerland, The Netherlands, and United Kingdom (UK) to investigate the prevalence and type of medications used by pregnant and breast-feeding women during the first pandemic wave. Factors associated with medication use were estimated by logistic regression. In total, 8378 women participated (i.e., 3666 pregnant and 4712 breastfeeding women). Most responses were collected in Norway (34%) and The Netherlands (28%), followed by Switzerland (19%), Ireland (17%) and UK (2%). Participants were more often professionally active and more often had a higher educational level compared to the general birthing population in each country. Overall, approximately 60% of women reported having used at least 1 medication in the preceding 3 months. Daily and occasional use was reported by 34% and 42% of pregnant and 29% and 44% of breastfeeding women. The most prevalent ATC (Anatomical Therapeutic Chemical) categories were the nervous system, the respiratory system, the alimentary tract/metabolism, and the musculo-skeletal system. Paracetamol, ibuprofen, antacids, and cetirizine were the most frequently used medications. The rate of antibacterial use was lower than previously reported. Having a chronic illness, country, maternal age, SARS-CoV-2 testing, professional status and time since delivery were associated with medication use. In conclusion, perinatal medication use was highly prevalent during the first pandemic wave, underlining the importance of maintaining counseling efforts on medication use, even in times of disrupted healthcare services and/or limited resources.
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Affiliation(s)
- Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium;
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands;
- L-C&Y, KU Leuven Child & Youth Institute, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-(16)-377227
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium;
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical Pharmacology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.P.); (V.L.)
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Valentine Lambelet
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.P.); (V.L.)
| | - Brian Cleary
- Rotunda Hospital, D01 P5W9 Dublin, Ireland; (B.C.); (F.O.)
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, D02 VN15 Dublin, Ireland
| | - Fergal O’Shaughnessy
- Rotunda Hospital, D01 P5W9 Dublin, Ireland; (B.C.); (F.O.)
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, D02 VN15 Dublin, Ireland
| | - Anneke Passier
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands;
| | - Jonathan Luke Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4AB, UK;
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway;
- Department of Child Health and Development, Norwegian Institute of Public Health, 0213 Oslo, Norway
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Miao XY, Miao XN, Ye LY, Cheng H. Image Enhancement Model Based on Deep Learning Applied to the Ureteroscopic Diagnosis of Ureteral Stones during Pregnancy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:9548312. [PMID: 34745329 PMCID: PMC8570888 DOI: 10.1155/2021/9548312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the image enhancement model based on deep learning on the effect of ureteroscopy with double J tube placement and drainage on ureteral stones during pregnancy. We compare the clinical effect of ureteroscopy with double J tube placement on pregnancy complicated with ureteral stones and use medical imaging to diagnose the patient's condition and design a treatment plan. METHODS The image enhancement model is constructed using deep learning and implemented for quality improvement in terms of image clarity. In the way, the relationship of the media transmittance and the image with blurring artifacts was established, and the model can estimate the ureteral stone predicted map of each region. Firstly, we proposed the evolution-based detail enhancement method. Then, the feature extraction network is used to capture blurring artifact-related features. Finally, the regression subnetwork is used to predict the media transmittance in the local area. Eighty pregnant patients with ureteral calculi treated in our hospital were selected as the research object and were divided into a test group and a control group according to the random number table method, 40 cases in each group. The test group underwent ureteroscopy double J tube placement, and the control group underwent ureteroscopy lithotripsy. Combined with the ultrasound scan results of the patients before and after the operation, the operation time, time to get out of bed, and hospitalization time of the two groups of patients were compared. The operation success rate and the incidence of complications within 1 month after surgery were counted in the two groups of patients. RESULTS We are able to improve the quality of the images prior to medical diagnosis. The total effective rate of the observation group was 100.0%, which is higher than that of the control group (90.0%). The difference between the two groups was statistically significant (P < 0.05). The adverse reaction rate in the observation group was 5.0%, which was lower than 17.5% in the control group. The difference between the two groups was statistically significant (P < 0.05). The comparison results are then prepared. CONCLUSIONS The image enhancement model based on deep learning is able to improve medical diagnosis which can assist radiologists to better locate the ureteral stones. Based on our method, double J tube placement under ureteroscopy has a significant effect on the treatment of ureteral stones during pregnancy, and it has good safety and is worthy of widespread application.
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Affiliation(s)
- Xiao-Yan Miao
- Department of Radiation Oncology, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| | - Xiao-Nan Miao
- Department of Endocrinology, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| | - Li-Yin Ye
- Department of Urology, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| | - Hong Cheng
- Department of Ultrasound, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
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20
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Abstract
Sexual dysfunction is defined as any abnormality in sexual arousal, libido, intercourse, orgasm, or satisfaction. It is prevalent in patients with chronic and end-stage kidney disease, with 70% to 84% of men and 30% to 60% of women reporting some form of sexual dysfunction. Although kidney transplantation improves the overall quality of life for patients receiving dialysis, it can have unexpected effects on sexual function owing to the use of immunosuppressive medications and comorbid illnesses. It is important to recognize these adverse effects and pre-emptively discuss them with patients to help mitigate consequent psychosocial discontent. Women of reproductive age will often recover fertility after kidney transplantation and therefore need to be empowered to prevent unwanted pregnancies and plan for a safe pregnancy if desired. Complications such as preeclampsia, pregnancy-induced hypertension, gestational diabetes, ectopic pregnancy, still birth, low birth weight, and preterm birth are more common in pregnant women with a kidney transplant. Careful monitoring for infection, rejection, and immunosuppressive dose adjustment along with comanagement by a high-risk obstetrician is of utmost importance. Breast-feeding is safe with most immunosuppressive medications and should be encouraged.
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21
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Benner M, Lopez-Rincon A, Thijssen S, Garssen J, Ferwerda G, Joosten I, van der Molen RG, Hogenkamp A. Antibiotic Intervention Affects Maternal Immunity During Gestation in Mice. Front Immunol 2021; 12:685742. [PMID: 34512624 PMCID: PMC8428513 DOI: 10.3389/fimmu.2021.685742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/03/2021] [Indexed: 12/19/2022] Open
Abstract
Background Pregnancy is a portentous stage in life, during which countless events are precisely orchestrated to ensure a healthy offspring. Maternal microbial communities are thought to have a profound impact on development. Although antibiotic drugs may interfere in these processes, they constitute the most frequently prescribed medication during pregnancy to prohibit detrimental consequences of infections. Gestational antibiotic intervention is linked to preeclampsia and negative effects on neonatal immunity. Even though perturbations in the immune system of the mother can affect reproductive health, the impact of microbial manipulation on maternal immunity is still unknown. Aim To assess whether antibiotic treatment influences maternal immunity during pregnancy. Methods Pregnant mice were treated with broad-spectrum antibiotics. The maternal gut microbiome was assessed. Numerous immune parameters throughout the maternal body, including placenta and amniotic fluid were investigated and a novel machine-learning ensemble strategy was used to identify immunological parameters that allow distinction between the control and antibiotic-treated group. Results Antibiotic treatment reduced diversity of maternal microbiota, but litter sizes remained unaffected. Effects of antibiotic treatment on immunity reached as far as the placenta. Four immunological features were identified by recursive feature selection to contribute to the most robust classification (splenic T helper 17 cells and CD5+ B cells, CD4+ T cells in mesenteric lymph nodes and RORγT mRNA expression in placenta). Conclusion In the present study, antibiotic treatment was able to affect the carefully coordinated immunity during pregnancy. These findings highlight the importance of inclusion of immunological parameters when studying the effects of medication used during gestation.
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Affiliation(s)
- Marilen Benner
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alejandro Lopez-Rincon
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands.,Department of Data Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Suzan Thijssen
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands.,Division of Immunology, Danone Nutricia Research B.V., Utrecht, Netherlands
| | - Gerben Ferwerda
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Irma Joosten
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renate G van der Molen
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Astrid Hogenkamp
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
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22
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Abstract
IMPORTANCE Rates of maternal sepsis are increasing, and prior studies of maternal sepsis have focused on immediate maternal morbidity and mortality associated with sepsis during delivery admission. There are no data on pregnancy outcomes among individuals who recover from their infections prior to delivery. OBJECTIVE To describe perinatal outcomes among patients with antepartum sepsis who did not deliver during their infection hospitalization. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using data from August 1, 2012, to August 1, 2018, at an academic referral center in San Francisco, California. Included patients were all individuals with nonanomalous, singleton pregnancies who delivered after 20 weeks' gestation during the study period. Data were analyzed from March 2020 through March 2021. EXPOSURES Antepartum admission for infection with clinical concern for sepsis and hospital discharge prior to delivery. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of perinatal outcomes associated with placental dysfunction and consisted of 1 or more of the following: fetal growth restriction, oligohydramnios, hypertensive disease of pregnancy, cesarean delivery for fetal indication, child who is small for gestational age, or stillbirth. RESULTS Among 14 565 patients with nonanomalous singleton pregnancies (mean [SD] age at delivery, 33.1 [5.2] years), 59 individuals (0.4%) were in the sepsis group and 14 506 individuals (99.6%) were in the nonsepsis group; 8533 individuals (59.0%) were nulliparous. Patients with sepsis, compared with patients in the reference group, were younger (mean [SD] age at delivery, 30.6 [5.7] years vs 33.1 [5.2] years; P < .001), were more likely to have pregestational diabetes (5 individuals [8.5%] vs 233 individuals [1.6%]; P = .003), and had higher mean (SD) pregestational body mass index scores (26.1 [6.1] vs 24.4 [5.9]; P = .03). In the sepsis group, the most common infections were urinary tract infections (24 patients [40.7%]) and pulmonary infections (22 patients [37.3%]). Among patients with sepsis, 5 individuals (8.5%) were admitted to the intensive care unit, the mean (SD) gestational age at infection was 24.6 (9.0) weeks, and the median (interquartile range) time from infection to delivery was 82 (42-147) days. Antepartum sepsis was associated with higher odds of placental dysfunction (21 patients [35.6%] vs 3450 patients [23.8%]; odds ratio, 1.77; 95% CI, 1.04-3.02; P = .04). On multivariable logistic regression analysis, antepartum sepsis was an independent factor associated with placental dysfunction (adjusted odds ratio, 1.88; 95% CI, 1.10-3.23; P = .02) after adjusting for possible confounders. CONCLUSIONS AND RELEVANCE This study found that pregnancies complicated by antepartum sepsis were associated with higher odds of placental dysfunction. These findings suggest that increased antenatal surveillance should be considered for these patients.
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Affiliation(s)
- Christine A. Blauvelt
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco
| | - Kiana C. Nguyen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco
| | - Arianna G. Cassidy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco
| | - Stephanie L. Gaw
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco
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23
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Fennell C, Diseko M, Zash R, Mayondi G, Mabuta J, Mmalane M, Davey S, Luckett R, Morroni C, Dintwa EN, Lockman S, Makhema J, Caniglia E, Shapiro R. The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana. Open Forum Infect Dis 2021; 8:ofab366. [PMID: 34381845 PMCID: PMC8351807 DOI: 10.1093/ofid/ofab366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana; it is treated with broad-spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. Methods The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. Obstetric record data collected from August 2014 to March 2019 were analyzed. Chi-square tests were conducted to compare proportions of maternal characteristics and infant outcomes. To avoid immortal time bias, all analyses were conducted among women who presented to care before 24 weeks gestation, with VDS categorized as present or absent by 24 weeks gestation. Log-binomial regression models were generated to determine associations between treated VDS and infant outcomes. Results VDS was diagnosed in 36 731 (30.7%) pregnant women, of whom 33 328 (90.7%) received antibiotics. Adjusted analyses yielded a harmful association between treated VDS and very preterm delivery (adjusted risk ratio, 1.11; 95% CI, 1.02-1.21). This association remained when restricting to women with VDS who received the recommended antibiotic treatment regimen. Sensitivity analyses produced nonsignificant associations when women with treated VDS were compared with women without VDS who received antibiotics for other indications. Conclusions A clinical diagnosis of VDS is common among pregnant women in Botswana, and the majority receive antibiotics in pregnancy. Although analyses of VDS occurring later in pregnancy are precluded by immortal time bias, a modest association between treated VDS and very preterm delivery was observed among women diagnosed with VDS by 24 weeks gestation.
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Affiliation(s)
- Christina Fennell
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Modeigi Diseko
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Rebecca Zash
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gloria Mayondi
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana
| | - Sonya Davey
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rebecca Luckett
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Scottish Livingston Hospital, Molepolole, Botswana.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Eldah N Dintwa
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Shahin Lockman
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Makhema
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ellen Caniglia
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Roger Shapiro
- Botswana-Harvard AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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24
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Awoke N, Tekalign T, Teshome M, Lolaso T, Dendir G, Obsa MS. Bacterial Profile and asymptomatic bacteriuria among pregnant women in Africa: A systematic review and meta analysis. EClinicalMedicine 2021; 37:100952. [PMID: 34386744 PMCID: PMC8343252 DOI: 10.1016/j.eclinm.2021.100952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Different physiologic changes that occur during pregnancy, such as Hydroureter, dilatation of the renal pelvis, glycosuria and aminoaciduria, and low urine production predispose pregnant women for ascending urinary tract infection. Globally, 2% to 15% of the pregnant women have urinary tract infection without specific symptoms. Therefore, this study aimed to estimate the prevalence of asymptomatic bacteriuria (ABU) in pregnant women in Africa. METHODS Systematic search of published studies done on PubMed, EMBASE, Web of Science, SCOPUS, PsychInfo, CINAHL, and google scholar for gray literature. All published observational studies until October 30, 2020 were included. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality of studies was assessed by modified Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using a random-effects method with the double arcsine transformation approach using the STATA™ Version 14 software. Trim and fill analysis was done to correct presence of significant publication bias. The study protocol is prospectively registered on PROSPERO, registration number CRD42020212601. FINDINGS From 3393 obtained studies, 48 studies from 12 African countries involving 15, 664 pregnant women included in this Meta-analysis. The overall pooled prevalence of asymptomatic bacteriuria among pregnant women in Africa after correction for publication bias by trim and fill analysis was found to be 11.1% (95% CI: 7.8, 14.4). The most common bacterial isolates involved in the etiology of ABU was Escherichia coli with pooled prevalence 33.4% (95% CI: 27.3 - 39.4). INTERPRETATION Asymptomatic bacteriuria is substantial among pregnant women in Africa. Therefore, all pregnant women should be tested for the presence of asymptomatic bacteriuria. A screening program must be based not only on the incidence but also on a cost-efficacy evaluation and a microbiological evaluation. FUNDING There was no funding source for this study.
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Affiliation(s)
- Nefsu Awoke
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Correspondence author.
| | - Tiwabwork Tekalign
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mistre Teshome
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tsegaye Lolaso
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getahun Dendir
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mohammed Suleiman Obsa
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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25
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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; 49:539-545. [PMID: 33554579 DOI: 10.1515/jpm-2020-0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although current guidelines advice to screen for asymptomatic bacteriuria during pregnancy, little is known about the best moment of testing. The goal of this study is to analyze the optimal timing (first vs. second trimester) to screen for asymptomatic bacteriuria during pregnancy. METHODS A retrospective cohort analysis, comparing patients that were screened for asymptomatic bacteriuria in the first vs. second trimester was performed. The main question was to compare the rate of positive urinary culture in both trimesters. Study included patients all followed a prenatal consultation at the University Hospital of Brussels between 2012 and 2017. Other outcomes considered were the nature of identified germs, treatments, possible risk and confounding factors (age, BMI, gravidity-parity-abortus [GPA], type of conception, ethnicity, education, prior urinary tract infection (UTI), diabetes, hypertension, prior preterm delivery and sickle cell disease) and complications (UTI, preterm delivery, preterm rupture of the membranes and chorio-amnionitis). RESULTS A total of 2,005 consecutive files were reviewed, 655 concerned patients screened during the first trimester group and 1,350 in the second trimester group. Asymptomatic bacteriuria was present in only 71 cases (3.54%), 23 in the first trimester group (3.50%) and 48 in the second trimester group (3.55%). Escherichia coli was the most frequently identified germ (37 cases (1.8%), 14 in the first trimester group and 23 in the second trimester group). Our logistic regression analysis shows no statistical difference according to the moment the urinary culture was done for the presence of asymptomatic bacteriuria (E. coli or others), for its association with hospitalization for pyelonephritis, preterm contractions, preterm pre-labor rupture of the membranes (PPROM) and/or preterm delivery. CONCLUSIONS If recommendations remain to screen for asymptomatic bacteriuria at least once during pregnancy, this study indicates that the moment of testing (first vs. second trimester) has no clinical impact on obstetrical outcomes.
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Affiliation(s)
| | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, University of Brussels, Brussels, Belgium
| | | | | | - Gilles Faron
- University Hospital of Brussels, Brussels, Belgium
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26
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Terzic M, Aimagambetova G, Terzic S, Radunovic M, Bapayeva G, Laganà AS. Periodontal Pathogens and Preterm Birth: Current Knowledge and Further Interventions. Pathogens 2021; 10:pathogens10060730. [PMID: 34207831 PMCID: PMC8227634 DOI: 10.3390/pathogens10060730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Preterm labor is defined as a birth before 37 weeks of gestation and occurs in 5–20% of pregnancies. Preterm labor, as multifactorial entity associated with a high risk of neonatal morbidity and mortality, is influenced by maternal, fetal and environmental factors. Microbiological studies suggest that infectious pathogens may account for 25–40% of preterm birth. Infections of different sites, like genital, urinary tract infections, and pneumonia, are linked to the preterm labor. The most recent epidemiological studies consistently report that maternal periodontal disease is associated with preterm delivery, as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes. On the other hand, some previously published papers found periodontal bacteria in placentas of term pregnancies. In spite of a huge research done on the topic, both experimental and clinical, there are many controversial opinions about the role of periodontal infections in preterm birth. Thus, this comprehensive review addresses this very important topic and evaluates novel strategies of preventive and therapeutic approaches.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
- Correspondence:
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.T.); (S.T.)
| | - Milena Radunovic
- Laboratory for Microbiology, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
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27
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Matalka A, Al-Husban N, Alkuran O, Almuhaisen L, Basha A, Eid M, Elmuhtaseb MS, Al Oweidat K. Spectrum of uropathogens and their susceptibility to antimicrobials in pregnant women: a retrospective analysis of 5-year hospital data. J Int Med Res 2021; 49:3000605211006540. [PMID: 33990142 PMCID: PMC8127801 DOI: 10.1177/03000605211006540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Urinary tract infections (UTI) are common during pregnancy. Identification of antimicrobial susceptibility patterns of microorganisms in pregnant women is important to select the most appropriate antimicrobial. We assessed common uropathogens in pregnant women with UTI and antimicrobial susceptibility, to guide empirical antibiotic selection. METHODS In this retrospective study, we analyzed mid-stream urine culture and antibiotic susceptibility data from pregnant women who attended Jordan University Hospital during 2014 to 2018. Data were collected from patients' charts and urine cultures, and sensitivity results were extracted from the laboratory electronic system. We calculated descriptive statistics and determined correlations among pathogens and antibiotics. RESULTS We examined 612 positive urine cultures from 559 pregnant women, including 163 (29.2%) inpatients. Escherichia coli (29.4%) was the most frequently identified microorganism, followed by coagulase-negative staphylococci (CoNS) (21.6%). All bacterial isolates were sensitive to aztreonam, chloramphenicol, fosfomycin, ofloxacin, pefloxacin, piperacillin, and colistin sulfate; 87.5% were sensitive to amikacin. Only 15.79%, 18.93%, and 17.91% were sensitive to oxacillin, nalidixic acid, and erythromycin, respectively. CONCLUSION E. coli and CoNS were the most commonly identified microorganisms in this study. We found increased antibiotic resistance in Enterobacter species. The chosen antimicrobial therapy in pregnancy should be determined by sensitivity/resistance and fetomaternal safety.
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Affiliation(s)
- Ala'a Matalka
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Naser Al-Husban
- Department of Obstetrics and Gynecology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Oqba Alkuran
- Department of Obstetrics and Gynecology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Lama Almuhaisen
- Department of Obstetrics and Gynecology, Al-Balqa Applied University, Amman, Jordan
| | - Asma Basha
- Department of Obstetrics and Gynecology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Eid
- Obstetrics and Gynecology, The University of Jordan and Jordan University Hospital, Amman, Jordan
| | | | - Khaled Al Oweidat
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Niederle B. [Hygiene measures in antenatal care]. DER GYNAKOLOGE 2021; 54:399-411. [PMID: 33976454 PMCID: PMC8103136 DOI: 10.1007/s00129-021-04794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND The prevention of infections in the obstetric care of pregnant women is paramount, on the one hand with regard to pathogens of congenital infections and on the other hand due to the association of maternal infections with premature delivery. OBJECTIVES Which measures are recommended for effective prevention of bacterial and viral diseases relevant to obstetrics? MATERIALS AND METHODS Literature search on hygiene measures in terms of preventing transmission of infection. RESULTS The physiological vaginal flora of the pregnant woman is a fundamental factor in natural defence against infection. Its disruption-also through antimicrobial therapies-has a proven influence on the course of pregnancy (premature rupture of membranes, premature birth). It also leads to a disturbed intestinal microbiome in newborns, which has long-term consequences for their neurological, respiratory, metabolic and immunological development and increases mortality. The focus should therefore be on prevention-rather than therapy-of infectious diseases during pregnancy. This requires a detailed anamnesis, monitoring and updating of the vaccination status and, if necessary, clarification of the infection status by means of targeted serological tests. Then the gynecologist can give individual advice on preventive measures. This article provides specific recommendations on selected obstetrically relevant infections. CONCLUSIONS Focusing on hygiene measures to prevent infection in obstetrics can improve the health of both mother and child.
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Affiliation(s)
- Bernhard Niederle
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten und Immenstadt, Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439 Kempten, Deutschland
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29
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Della Rosa PA, Miglioli C, Caglioni M, Tiberio F, Mosser KHH, Vignotto E, Canini M, Baldoli C, Falini A, Candiani M, Cavoretto P. A hierarchical procedure to select intrauterine and extrauterine factors for methodological validation of preterm birth risk estimation. BMC Pregnancy Childbirth 2021; 21:306. [PMID: 33863296 PMCID: PMC8052693 DOI: 10.1186/s12884-021-03654-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Etiopathogenesis of preterm birth (PTB) is multifactorial, with a universe of risk factors interplaying between the mother and the environment. It is of utmost importance to identify the most informative factors in order to estimate the degree of PTB risk and trace an individualized profile. The aims of the present study were: 1) to identify all acknowledged risk factors for PTB and to select the most informative ones for defining an accurate model of risk prediction; 2) to verify predictive accuracy of the model and 3) to identify group profiles according to the degree of PTB risk based on the most informative factors. Methods The Maternal Frailty Inventory (MaFra) was created based on a systematic review of the literature including 174 identified intrauterine (IU) and extrauterine (EU) factors. A sample of 111 pregnant women previously categorized in low or high risk for PTB below 37 weeks, according to ACOG guidelines, underwent the MaFra Inventory. First, univariate logistic regression enabled p-value ordering and the Akaike Information Criterion (AIC) selected the model including the most informative MaFra factors. Second, random forest classifier verified the overall predictive accuracy of the model. Third, fuzzy c-means clustering assigned group membership based on the most informative MaFra factors. Results The most informative and parsimonious model selected through AIC included Placenta Previa, Pregnancy Induced Hypertension, Antibiotics, Cervix Length, Physical Exercise, Fetal Growth, Maternal Anxiety, Preeclampsia, Antihypertensives. The random forest classifier including only the most informative IU and EU factors achieved an overall accuracy of 81.08% and an AUC of 0.8122. The cluster analysis identified three groups of typical pregnant women, profiled on the basis of the most informative IU and EU risk factors from a lower to a higher degree of PTB risk, which paralleled time of birth delivery. Conclusions This study establishes a generalized methodology for building-up an evidence-based holistic risk assessment for PTB to be used in clinical practice. Relevant and essential factors were selected and were able to provide an accurate estimation of degree of PTB risk based on the most informative constellation of IU and EU factors. Supplementary Information The online version contains supplementary material available at (10.1186/s12884-021-03654-3).
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Affiliation(s)
- Pasquale Anthony Della Rosa
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Cesare Miglioli
- Research Center for Statistics, University of Geneva, Boulevard du Pont-d'Arve 40, Geneva, 1205, Switzerland
| | - Martina Caglioni
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Francesca Tiberio
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Kelsey H H Mosser
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Edoardo Vignotto
- Research Center for Statistics, University of Geneva, Boulevard du Pont-d'Arve 40, Geneva, 1205, Switzerland
| | - Matteo Canini
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Cristina Baldoli
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Andrea Falini
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Paolo Cavoretto
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy.
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Majangara Karaga R. Concealed urogenital schistosomiasis causing chronic pelvic pain: A case report. Clin Case Rep 2021; 9:1860-1864. [PMID: 33936604 PMCID: PMC8077315 DOI: 10.1002/ccr3.3654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/28/2020] [Indexed: 11/09/2022] Open
Abstract
Urogenital schistosomiasis may mimic or co-exist with other disease. Clinicians should maintain a high index of suspicion for schistosomiasis in women from endemic areas and travelers to avoid significant morbidity and unnecessary interventions.
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31
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Case report : Actinomyces naeslundii complicating preterm labour in a trisomy-21 pregnancy. IDCases 2021; 23:e01051. [PMID: 33532241 PMCID: PMC7822938 DOI: 10.1016/j.idcr.2021.e01051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 11/21/2022] Open
Abstract
Actinomyces naeslundii causing preterm birth. Inappropriate antibiotics usage postpartum. Treatment of intrapartum Actinomyces naeslundii to prevent preterm birth.
Preterm birth is a global concern with considerable morbidity and mortality. Intrapartum infection is a known cause of preterm birth and Actinomyces infection is one of the infections contributing to preterm birth. We report a case of preterm birth of a trisomy-21 neonate to a mother with positive Actinomyces naeslundii from an intra-operative placental swab sample and discussed the relationship of this bacteria and preterm delivery, and the role of postpartum antibiotics use in this case.
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32
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White J, Ory J, Lantz Powers AG, Ordon M, Kroft J, Cox A. Urological issues in pregnancy: A review for urologists. Can Urol Assoc J 2020; 14:352-357. [PMID: 32432535 PMCID: PMC7716830 DOI: 10.5489/cuaj.6526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.
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Affiliation(s)
- Joshua White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Michael Ordon
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Warning of Immortal Time Bias When Studying Drug Safety in Pregnancy: Application to Late Use of Antibiotics and Preterm Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186465. [PMID: 32899455 PMCID: PMC7558278 DOI: 10.3390/ijerph17186465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/22/2022]
Abstract
This study aimed to illustrate and account for immortal time bias in pregnancy observational investigations, using the relationship between late use of antibiotics and risk of preterm birth as an example. We conducted a population-based cohort study including 549,082 deliveries between 2007 and 2017 in Lombardy, Italy. We evaluated the risk of preterm births, low birth weight, small for gestational age, and low Apgar score associated with antibiotic dispensing during the third trimester of pregnancy. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of the outcomes, considering the use of antibiotics as time-fixed (with biased classification of exposure person-time) and time-varying (with proper classification of exposure person-time) exposure. There were 23,638 (4.3%) premature deliveries. There was no association between time-fixed exposure to antibiotics and preterm delivery (adjusted HR 0.96; 95% CI 0.92 to 1.01) but an increased risk of preterm birth when time-varying exposure to antibiotics was considered (1.27; 1.21 to 1.34). The same trend was found for low birth weight and low Apgar score. Immortal time bias is a common and sneaky trap in observational studies involving exposure in late pregnancy. This bias could be easily avoided with suitable design and analysis.
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Abstract
Inconsistencies persist regarding the efficacy of treating asymptomatic group B Streptococcus bacteriuria in pregnant individuals with colony counts below 10 (100,000) CFU/mL. Despite these discrepancies, treatment still occurs. This article examines the role of screening and treatment, evidence-based guidelines, and practice patterns to provide clarification and resolve local practice disparities.
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