title: Pyelonephritis in pregnancy. How adequate is empirical treatment?
abstract: OBJECTIVE
  To ascertain the adequacy of empirical antimicrobial treatment in pregnant women with acute pyelonephritis.
  
  
  METHODS
  We have conducted a retrospective observational study of women admitted to the hospital with acute pyelonephritis between May 2004 and April 2011. Patients were included if the results of urine cultures and susceptibility testing to antibiotics were available. Epidemiological, clinical, therapeutical and outcome variables were collected from chart review. We considered inappropriate empirical antimicrobial treatment (IEAT) as the occurrence of microorganism that were not effectively treated at the time when the causative microorganism and its antibiotic susceptibility were known.
  
  
  RESULTS
  Fifty women with appropriate microbiological data from a total of 93 cases of acute pyelonephritis were included in the study. The women's mean age was 26.4 years, and 58% were nulliparous. Pyelonephritis was developed in the 2nd and 3rd trimester in 88% of cases. Previous urinary tract infections were recorded in 34%. Escherichia coli was the most frequent microorganism (70%). The proportion of patients who received IEAT was 10%. Amoxicillin-clavulanate and cephalosporines were the most predominant antibiotics used, with a proportion of IEAT of 10.3% and 5.9%, respectively.
  
  
  CONCLUSIONS
  Pregnant women with pyelonephritis received IEAT in a small but significant number of cases. Amoxicillin-clavulante and cephalosporines were adequate in most cases. More studies are needed to define the clinical impact of IEAT on prognosis.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Dr. Peset, Av. Gaspar Aguilar 90, 46010 Valencia, Spain. arturo.artero@uv.es
authors.forename: Arturo
authors.initials: A
authors.lastname: Artero
authors.forename: Juan
authors.initials: J
authors.lastname: Alberola
authors.forename: José María
authors.initials: JM
authors.lastname: Eiros
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Nogueira
authors.forename: Antonio
authors.initials: A
authors.lastname: Cano
mesh_terms: D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015897:Comorbidity; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology; D011704:Pyelonephritis / Q000188:drug therapy* / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D005578:Fosfomycin; D019980:Amoxicillin-Potassium Clavulanate Combination