Prevalence of antibiotic-resistant uropathogens in obstetric patients with acute pyelonephritis.
The purpose of this investigation was to determine the prevalence of antibiotic-resistant uropathogens in 121 pregnant patients hospitalized with acute pyelonephritis. We obtained urine for culture by catheterization and defined a positive culture as greater than 100 colony-forming units per milliliter of urine. We determined bacterial sensitivities with either the Bauer-Kirby disc diffusion test or the Vitek Auto Microbic System. During the 4 years of the study, the prevalence of ampicillin-resistant organisms was 26% (95% confidence interval 18-34%). However, only 4% (95% confidence interval 0-8%) of the uropathogens were resistant to limited-spectrum, first-generation cephalosporins. This observed difference in antibiotic sensitivity was highly significant (P less than .005). Therefore, we conclude that a limited-spectrum cephalosporin is more appropriate than ampicillin for empirical therapy of pyelonephritis in pregnancy.
Dunlow
S
S
Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Tacoma, Washington.
Duff
P
P
D000208:Acute Disease; D000667:Ampicillin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology / Q000382:microbiology*; D011704:Pyelonephritis / Q000188:drug therapy / Q000382:microbiology*; D018805:Sepsis / Q000453:epidemiology; D012772:Shock, Septic / Q000453:epidemiology; D014556:Urine / Q000382:microbiology
D002511:Cephalosporins; D000667:Ampicillin