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- W2997663299 abstract "Outside pregnancy, nitrofurantoin, ciprofloxacin and sulfamethoxazole/trimethoprim(SMZ-TMP) are first-line therapy(FLT) for urinary tract infections(UTI). This has been extrapolated to pregnancy based on expert opinion adjusting for medication safety. We compare progression to pyelonephritis(pyelo) and adverse obstetric outcomes between women who receive FLT and those given alternative antibiotics(abx), such as beta-lactams. Retrospective cohort of women with asymptomatic bacteriuria(ASB) or UTI at one healthcare system from 7/2013-5/2019. Women without documentation of abx compliance were excluded. FLT was defined as nitrofurantoin or SMZ-TMP. Other abx were considered not first-line(nFLT). Women in the FLT group were compared to those in the nFLT group in terms of progression to pyelo. Secondary outcomes included pyelo-related anemia, sepsis, pyelo length of stay, preterm delivery and low birth weight(LBW). Logistic regression was used to calculate odds of outcomes. Secondary analysis assessing impact of nFLT on outcomes in women with gram-negative(GN) infections was performed. Of 261 women, 186(71%) received FLT and 75(29%) received nFLT. Women given FLT were more likely depressed, but less likely to have HTN and BMI≥40(Table 1). Rates of progression to pyelo did not differ(12.3%vs9.3%;p=NS). Secondary pyelo outcomes did not differ, but LBW was less common among women given FLT(Table 2). After controlling for h/o UTI, treatment duration< 7 days, and BMI≥40, no difference in odds of progression to pyelo was seen(aOR1.39, 95%CI0.55,3.52). However, treatment with FLT was associated with 69% lower odds of LBW(aOR0.31,95%CI 0.12,0.79) after controlling for confounders. Among GN infections, no difference in progression of pyelo was seen, but odds of LBW remained lower in the FLT group(aOR0.20,95%CI 0.05,0.76). Receipt of abx other than nitrofurantoin or SMZ-TMP for UTI in pregnancy was not associated with increased risk of progression to pyelo, but was associated with low birth weight. Larger studies are needed to confirm these data.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
- W2997663299 created "2020-01-10" @default.
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- W2997663299 date "2020-01-01" @default.
- W2997663299 modified "2023-10-16" @default.
- W2997663299 title "268: Beyond expert opinion: A comparison of antibiotic regimens for infectious urinary tract pathology in pregnancy" @default.
- W2997663299 doi "https://doi.org/10.1016/j.ajog.2019.11.284" @default.
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