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Ansaldi Y, Martinez de Tejada Weber B. Urinary tract infections in pregnancy. Clin Microbiol Infect 2023; 29:1249-1253. [PMID: 36031053 DOI: 10.1016/j.cmi.2022.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the most common infection among pregnant women and have been associated with maternal and foetal complications. Antimicrobial exposure during pregnancy is not without risk. International guidelines recommend a single screen-and-treat approach to asymptomatic bacteriuria (ASB); however, this approach has been questioned by recent studies. OBJECTIVES The aim of this narrative review was to assess the pathophysiology, current risk factors and management of UTI during pregnancy, its impact on pregnancy outcomes, and to develop recommendations on the best use of antimicrobials. SOURCES PubMed, Cochrane database, and ClinicalTrials.gov. CONTENT Owing to the physiological changes related to pregnancy, pregnant women are at higher risk of UTI. All types of UTIs combined have been estimated to affect approximately 2% to 15% of women. ASB affects 2% to 7% of pregnant women. Recent studies do not provide good-quality evidence for an association between ASB and acute pyelonephritis if ASB is untreated. There is low-to-moderate-quality evidence that treatment of ASB results in a reduction in the incidence of low birth weight and preterm birth, which justifies screening practices for ASB with only a single urine culture in the first trimester. If the clinician opts for treatment, a short course of β-lactams, nitrofurantoin, or fosfomycin should be favoured. Studies on cystitis during pregnancy are limited. Acute pyelonephritis has been shown to be associated with increased maternal complications and in some studies has also been associated with preterm delivery and low birth weight. Preferred antimicrobials for the management of pyelonephritis are amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems. Studies on recurrent UTIs during pregnancy are limited, making it difficult to draw conclusions regarding prophylactic measures. IMPLICATIONS Further research is required to understand the true incidence of ASB-related complications and the benefit and modalities of screening for ASB and to further explore prophylactic measures.
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Affiliation(s)
- Yveline Ansaldi
- Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
| | - Begoña Martinez de Tejada Weber
- Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Studying Pregnancy Outcome Risk in Patients with Systemic Lupus Erythematosus Based on Cluster Analysis. BIOMED RESEARCH INTERNATIONAL 2023. [DOI: 10.1155/2023/3668689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background. Pregnancy in systemic lupus erythematosus (SLE) patients is a challenge due to the potential maternal and fetal complications. Therefore, a multidisciplinary assessment of disease risk before and during pregnancy is essential to improve pregnancy outcomes. Objectives. Our purpose was to (i) define clusters of patients with similar history and laboratory features and determine the associative maternal and perinatal outcomes and (ii) evaluate the risk spectrum of maternal and perinatal outcomes of pregnancy in SLE patients, represented by our established risk-assessment chart. Methods. Medical records of 119 patients in China were analyzed retrospectively. Significant variables with
were selected. The self-organizing map was used for clustering the data based on historical background and laboratory features. Results. Clustering was conducted using 21 maternal and perinatal features. Five clusters were recognized, and their prominent maternal manifestations were as follows: cluster 1 (including 27.73% of all patients): preeclampsia and lupus nephritis; cluster 2 (22.69%): oligohydramnios, uterus scar, and femoral head necrosis; cluster 3 (13.45%): upper respiratory tract infection; cluster 4 (15.97%): premature membrane rupture; and cluster 5 (20.17%): no problem. Conclusion. Pregnancy outcomes in SLE women fell into three categories, namely high risk, moderate risk, and low risk. Present manifestations, besides the medical records, are a potential assessment means for better management of pregnant SLE patients.
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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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Gehani M, Kapur S, Madhuri SD, Pittala VP, Korvi SK, Kammili N, Sharad S. Effectiveness of antenatal screening of asymptomatic bacteriuria in reduction of prematurity and low birth weight: Evaluating a point-of-care rapid test in a pragmatic randomized controlled study. EClinicalMedicine 2021; 33:100762. [PMID: 33842864 PMCID: PMC8020147 DOI: 10.1016/j.eclinm.2021.100762] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Premature babies suffer higher mortality and life-long disabilities. Asymptomatic bacteriuria (ASB) is postulated to induce preterm labor. Routine antenatal screening for ASB using urine culture is not feasible in most developing countries due to long turn-around time, user-unfriendliness, and lack of resources. The current parallel-group superiority pragmatic randomized controlled trial evaluated the effect of screening and evidence-based treatment of ASB using an optical-sensor-based point-of-care rapid-test on the incidence of preterm birth and low birthweight (LBW). METHODS 240 consenting asymptomatic pregnant women visiting an Indian tertiary public hospital for first antenatal check-up, irrespective of trimester/gravida, who had not consumed antibiotics in the preceding week, were enrolled from February-May 2017. Computer-generated concealed simple randomization allocation sequence was used to assign participants to intervention (120) and control arm (120). Usual hospital-care was provided in the control arm. In the intervention arm, urine samples were additionally screened for ASB using the rapid-test and the positive women were prescribed susceptible antibiotics. Blinded outcome assessors followed up with women post-delivery. The study was registered with the Clinical Trials Registry-India (CTRI/2016/09/007240). FINDINGS 213 participants were analyzed (intervention: 103, control: 110). 21 women were found positive for ASB and prescribed pathogen-specific antibiotics. The incidence of preterm birth/LBW in intervention arm (n = 27) was lower than control arm (n = 45) by 14·7% (95% CI: 2·2-27·2); RR: 0.64, (95% CI: 0·43-0·95); p = 0·023, X2=5·13. INTERPRETATION Rapid-test-guided treatment for ASB reduced the incidence of preterm birth/LBW in a pragmatic setting without any adverse event. FUNDING Department of Biotechnology, Government of India.
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Affiliation(s)
- Manish Gehani
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Suman Kapur
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Hyderabad 500078, India
| | - Sudha D Madhuri
- Department of Microbiology, Gandhi Medical College and Hospital, Secunderabad 500003, India
| | | | | | - Nagamani Kammili
- Department of Microbiology, Gandhi Medical College and Hospital, Secunderabad 500003, India
| | - Shashwat Sharad
- Center for Prostate Disease Research, John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, United States
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Kapur S, Gehani M, Kammili N, Bhardwaj P, Nag V, Devara SM, Sharad S. Clinical Validation of Innovative Optical-Sensor-Based, Low-Cost, Rapid Diagnostic Test to Reduce Antimicrobial Resistance. J Clin Med 2019; 8:E2098. [PMID: 31805738 PMCID: PMC6947486 DOI: 10.3390/jcm8122098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022] Open
Abstract
The antibiotic susceptibility test determines the most effective antibiotic treatment for bacterial infection. Antimicrobial stewardship is advocated for the rational use of antibiotics to preserve their efficacy in the long term and provide empirical therapy for disease management. Therefore, rapid diagnostic tests can play a pivotal role in efficient and timely treatment. Here, we developed a novel, rapid, affordable, and portable platform for detecting uropathogens and reporting antibiogram to clinicians in just 4 h. This technology replicates the basic tenets of clinical microbiology including bacterial growth in indigenously formulated medium, and measurement of inhibition of bacterial growth in presence of antibiotic/s. Detection is based on chromogenic endpoints using optical sensors and is analyzed by a lab-developed algorithm, which reports antibiotic sensitivity to the antibiotics panel tested. To assess its diagnostic accuracy, a prospective clinical validation study was conducted in two tertiary-care Indian hospitals. Urine samples from 1986 participants were processed by both novel/index test and conventional Kirby Bauer Disc Diffusion method. The sensitivity and specificity of this assay was 92.5% and 82%, respectively (p < 0.0005). This novel technology will promote evidence-based prescription of antibiotics and reduce the burden of increasing resistance by providing rapid and precise diagnosis in shortest possible time.
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Affiliation(s)
- Suman Kapur
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Hyderabad, Telangana 500078, India;
| | - Manish Gehani
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Hyderabad, Telangana 500078, India;
| | - Nagamani Kammili
- Department of Microbiology, Gandhi Medical College and Hospital, Hyderabad, Telangana 500003, India; (N.K.); (S.M.D.)
| | - Pankaj Bhardwaj
- All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India; (P.B.); (V.N.)
| | - Vijayalakshmi Nag
- All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India; (P.B.); (V.N.)
| | - Sudha M. Devara
- Department of Microbiology, Gandhi Medical College and Hospital, Hyderabad, Telangana 500003, India; (N.K.); (S.M.D.)
| | - Shashwat Sharad
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20817, USA
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