title: Adherence to evidence-based guidelines for the management of pyelonephritis in pregnancy.
abstract: BACKGROUND
  Pyelonephritis occurs in approximately two per cent of pregnancies and can cause significant maternal and fetal morbidity and mortality. Evidence-based guidelines recommend appropriate antibiotic therapy, urine culture for test of cure after treatment and monthly follow-up cultures until delivery.
  
  
  OBJECTIVE
  To evaluate adherence to guidelines for the management of antepartum pyelonephritis within an Australian obstetric population and to assess associations with noncompliance.
  
  
  METHODS
  A retrospective study was performed for the 103 pregnant women admitted with pyelonephritis between January 2001 and December 2009 at the Royal Brisbane and Women's Hospital, a tertiary referral obstetric hospital. We assessed baseline characteristics, the frequency of appropriate treatment and follow-up, and any associations among these.
  
  
  RESULTS
  The guideline recommended antibiotic treatment was prescribed in 90.3% of women. Of the women with antibiotic-resistant organisms, 31.6% had their antibiotics changed appropriately. The test of cure urine culture was performed in only 35.0% of women after treatment completion. Inadequate long-term follow-up occurred in 60.2% of the cohort studied. Inappropriate follow-up was associated with low socioeconomic status (P=0.04), unemployment (P=0.04) and the absence of a test of cure urine culture (P=0.001).
  
  
  CONCLUSIONS
  The empiric treatment of antepartum pyelonephritis is generally appropriate; however, antibiotic changes for bacterial resistance are inadequate. Test of cure and monthly follow-up urine cultures are infrequently performed despite their recommendation in published treatment guidelines.
authors.affiliation: School of Medicine, University of Queensland, Brisbane, QLD, Australia. michelle.ennis@uqconnect.edu.au
authors.forename: Michelle
authors.initials: M
authors.lastname: Ennis
authors.forename: Leonie
authors.initials: L
authors.lastname: Callaway
authors.forename: Karin
authors.initials: K
authors.lastname: Lust
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D011203:Poverty; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine*; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine*; D011793:Queensland; D012189:Retrospective Studies; D014478:Unemployment; D014556:Urine / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents