BACKGROUND
The introduction of antibiotics has significantly reduced morbidity and mortality
from microbial infections, but the rise of antibiotic-resistant and multidrug-resistant
microbes is of increasing clinical concern. Few studies have examined the prevalence
and impact of antibiotic resistance in common antenatal infections.
OBJECTIVE
This study aimed to determine whether pregnant women with a urine culture positive
for antibiotic-resistant or multidrug-resistant gram-negative bacteria are at increased
risk of developing pyelonephritis than pregnant women infected with antibiotic-susceptible
organisms.
STUDY DESIGN
This was a retrospective cohort study of pregnant women with asymptomatic bacteriuria
or acute cystitis from a single health system from July 2013 to May 2019. Women with
gram-negative antibiotic-resistant (resistance to 1–2 antibiotic classes) and multidrug-resistant
(resistance to ≥3 antibiotic classes) lower urinary tract infections were compared
with women with antibiotic-susceptible urinary tract infections in terms of demographic,
infectious, antepartum, and intrapartum data. The primary outcome was pyelonephritis,
defined as a billing code for pyelonephritis plus fever or flank pain. The secondary
outcomes were length of stay in the hospital because of pyelonephritis, a composite
of pyelonephritis complications (renal abscess, sepsis, and intensive care unit admission),
and preterm delivery. The differences in the primary outcome were analyzed using multivariate
logistic regression.
RESULTS
A total of 573 women were eligible for inclusion. Of the 573 women, 334 (58%) had
gram-negative bacteria on urine culture. Of the 334 cases, 173 (52%) were antibiotic
susceptible, 74 (22%) were antibiotic resistant, and 87 (26%) were multidrug resistant.
Women with antibiotic-resistant and multidrug-resistant infections were more likely
to have hypertension (P=.004), to be Black (P=.03), to have public insurance (P=.002), and to experience more urinary infections (P=.001). Pyelonephritis was more common in women with antibiotic-resistant (adjusted
odds ratio, 2.27; 95% confidence interval, 1.08–4.78) and multidrug-resistant (adjusted
odds ratio, 3.06; 95% confidence interval, 1.57–5.96) infections than in women with
antibiotic-susceptible urinary tract infections. Length of stay, preterm delivery,
and pyelonephritis complications did not differ between antibiotic-susceptible and
antibiotic-resistant and multidrug-resistant infections.
CONCLUSION
In an age of increasing antibiotic resistance, more than one-half of pregnant women
with bacteriuria experience at least 1 infection with an antibiotic-resistant organism.
These resistance patterns have a real clinical impact as pregnant women with antibiotic-resistant
gram-negative lower urinary tract infections have an estimated 2- to 3-fold increased
odds of developing pyelonephritis.
Key words
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Article info
Publication history
Published online: November 29, 2021
Accepted:
November 23,
2021
Received in revised form:
November 13,
2021
Received:
September 20,
2021
Footnotes
The authors report no conflict of interest.
Research reported in this publication was supported by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under award number TL1 TR002555. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The NCATS had no involvement in the study design, collection, analysis, and interpretation of data, writing the report, or decision to submit this article for publication.
This study was presented in a poster format at the 40th annual meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, February 3–8, 2020.
Data presented in this manuscript are available on request.
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