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Chen X, Cao S, Fu X, Ni Y, Huang B, Wu J, Chen L, Huang S, Cao J, Yu W, Ye H. The risk factors for Group B Streptococcus colonization during pregnancy and influences of intrapartum antibiotic prophylaxis on maternal and neonatal outcomes. BMC Pregnancy Childbirth 2023; 23:207. [PMID: 36973793 PMCID: PMC10041798 DOI: 10.1186/s12884-023-05478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS), also referred as Streptococcus agalactiae, is one of the leading causes of life-threatening invasive diseases such as bacteremia, meningitis, pneumonia and urinary tract infection in pregnant women and neonates. Rates of GBS colonization vary by regions, but large-sample studies on maternal GBS status are limited in southern China. As a result, the prevalence of GBS among pregnant women and its associated risk factors and the efficacy of intrapartum antibiotic prophylaxis (IAP) intervention in preventing adverse pregnancy and neonatal outcomes remain poorly understood in southern China. METHODS To fill this gap, we retrospectively analyzed demographic and obstetrical data of pregnant women who have undergone GBS screening and delivered between 2016 and 2018 in Xiamen, China. A total of 43,822 pregnant women were enrolled and only a few GBS-positive women did not receive IAP administration. Possible risk factors for GBS colonization were assayed by univariate and multivariate logistic regression analysis. Generalized linear regression model was applicated to analyze whether IAP is one of the impact factors of the hospital length of stay of the target women. RESULTS The overall GBS colonization rate was 13.47% (5902/43,822). Although women > 35 years old (P = 0.0363) and women with diabetes mellitus (DM, P = 0.001) had a higher prevalence of GBS colonization, the interaction between ages and GBS colonization was not statistically significant in Logistic Regression analysis (adjusted OR = 1.0014; 95% CI, 0.9950, 1.0077). The rate of multiple births was significantly dropped in GBS-positive group than that of GBS-negative group (P = 0.0145), with no significant difference in the rate of fetal reduction (P = 0.3304). Additionally, the modes of delivery and the incidences of abortion, premature delivery, premature rupture of membranes, abnormal amniotic fluid and puerperal infection were not significantly different between the two groups. The hospitalization stays of the subjects were not influenced by GBS infection. As for neonatal outcomes, the cases of fetal death in maternal GBS-positive group did not statistically differ from that in maternal GBS-negative group. CONCLUSION Our data identified that pregnant women with DM are at high risk of GBS infection and IAP is highly effective in prevention of adverse pregnancy and neonatal outcomes. This stressed the necessity of universal screening of maternal GBS status and IAP administration to the target population in China, and women with DM should be considered as priorities.
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Affiliation(s)
- Xiaoli Chen
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
- School of Basic Medical Science, Fujian Medical University, Fuzhou, China
| | - Sijia Cao
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaochun Fu
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Yan Ni
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Bixuan Huang
- School of Public Health, Xiamen University, Xiamen, China
| | - Jiayin Wu
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Ling Chen
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Shuying Huang
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jiali Cao
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Weiwei Yu
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.
| | - Huiming Ye
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.
- School of Public Health, Xiamen University, Xiamen, China.
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Zhang M, Jin H, Liu X. Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Stents in a Pregnant Woman: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e936967. [PMID: 35943910 PMCID: PMC9375650 DOI: 10.12659/ajcr.936967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/29/2022] [Accepted: 06/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Bacteriuria occurs in many pregnant women which may result in symptomatic urinary tract infection (UTI), including acute pyelonephritis (APN), which can lead to septic shock. However, there was no standard protocol of managing pregnant women with APN about the regimen, timing, length of antibiotic appliance as well as the indication of implanting double-J ureteral stents in those with kidney stones. CASE REPORT A 26-year-old pregnant woman (G1P0, 27 weeks plus 3 days) presented to our hospital on account of fever and pain in the flanks and was admitted on account of suspected UTI due to bacteriuria and elevated inflammatory markers. Elevated WBC count of 18.26×10⁹/L, PCT of 2.75, CRP of 198 mg/L, existence of kidney stones, renal and perirenal inflammation were observed. Cefoperazone sodium sulbactam sodium was given. The patient experienced septic shock on day 2 with a low blood pressure of 81/52 mmHg. Double-J ureteral stents were implanted due to upper urinary tract obstruction on day 3 with continuous use of meropenem based on urine culture and antibiotic sensitivity results. From day 7, the antibiotics were changed to cefoperazone-sulbactam. The patient's laboratory results (biochemistry, PCT, and CRP) all gradually went to normal, and she was discharged on day 15. CONCLUSIONS We learned that urine culture and antibiotic sensitivity examination were suggested after bacteriuria was observed in pregnant women to guide further treatment. Once APN was suspected, antibiotic therapy should be commenced and early-stage drainage by double-J ureteral stents could be considered if warranted in appropriate patients.
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Affiliation(s)
- Man Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, PR China
| | - Hongyu Jin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, PR China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, PR China
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Radu VD, Vasilache IA, Costache RC, Scripcariu IS, Nemescu D, Carauleanu A, Nechifor V, Groza V, Onofrei P, Boiculese L, Socolov D. Pregnancy Outcomes in a Cohort of Patients Who Underwent Double-J Ureteric Stenting-A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:619. [PMID: 35630036 PMCID: PMC9147179 DOI: 10.3390/medicina58050619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Minimally invasive procedures, such as double-J ureteric stenting, could be a promising therapeutic alternative to conservative management of obstructive urinary tract pathology. We aimed to evaluate the safety and effectiveness of double-J ureteric stenting in pregnant women with ureterohydronephrosis or urolithiasis, along with their infectious complications, and to assess the pregnancy outcomes of this cohort of patients in comparison with a control group. Materials and Methods: This observational retrospective study included 52 pregnant patients who underwent double-J ureteric stenting for urologic disorders in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital- ‘Cuza-Voda’, Iasi, Romania. The control group (63 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital, without urinary pathology. Clinical, sonographic, and laboratory variables were examined. Descriptive statistics, non-parametric tests, and a one-to-one propensity score-matched analysis were used to analyze our data. Results: The univariate analysis indicated a significant statistical difference between the control group and the interventional group regarding maternal age (p = 0.018), previous maternal history of renal colic (p = 0.005) or nephrolithiasis (p = 0.002). After applying the propensity score-matched analysis, cesarean delivery rates (p < 0.001), preterm labour (p = 0.039), premature rupture of membranes (p = 0.026), preterm birth rates (p = 0.002), and post-partum UTI rates (p = 0.012) were significantly different between the control group and the matched treatment group. Ureterohydronephrosis, whether simple (n = 37; 71.2%) or infected (n = 13; 25%), was the main indication for double-J ureteric stenting. Complications such as pain (n = 21; 40.3%), stent migration (n = 3; 5.76%) or encrustation (n = 2; 3.84%), as well as reflux pyelonephritis (n = 2; 3.84%) and gross hematuria (n = 1; 1.92%) were recorded during follow-up. Conclusions: Our results show that double-J stenting is a safe and effective treatment option for pregnant patients with obstructive urological disorders.
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Affiliation(s)
- Viorel Dragos Radu
- Urology Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.D.R.); (R.-C.C.)
- Urology Department, ‘C.I. Parhon’ University Hospital, 700115 Iasi, Romania;
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Radu-Cristian Costache
- Urology Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.D.R.); (R.-C.C.)
- Urology Department, ‘C.I. Parhon’ University Hospital, 700115 Iasi, Romania;
| | - Ioana-Sadiye Scripcariu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Alexandru Carauleanu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Valentin Nechifor
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
| | - Veaceslav Groza
- Urology Department, ‘C.I. Parhon’ University Hospital, 700115 Iasi, Romania;
| | - Pavel Onofrei
- Morphofunctional Sciences II Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Lucian Boiculese
- Medical Informatics and Biostatistics Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-S.S.); (D.N.); (A.C.); (V.N.); (D.S.)
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