Pielonefrite

Acta Obstet Ginecol Port 2008;2(4):173-177

Artigo Original/Original Article

Pielonefrite na gravidez
Pyelonephritis in pregnancy
Filipa Passos*, Nuno Clode**, Luís Mendes-da-Graça***
Hospital de Santa Maria, Faculdade de Medicina da Universidade de Lisboa
ABSTRACT
Objectives – To evaluate risk factors, obstetric complications, microbial pathogens, and their resistance to common antibiotics in pregnant women with acute pyelonephritis.
Design – Retrospective observational study
Setting – A tertiary care university hospital
Methods – We reviewed patient files of all pregnant women admitted in our institution, from January
2005 to January 2008 with a diagnosis of acute pyelonephritis. General demographic data, maternal risk factors, microbial pathogens isolated in urine samples and in vitro susceptibility to antibiotics, recurrent episodes, and pregnancy outcomes were extracted.
Results – One hundred and twelve pregnant women were admitted with the diagnosis of acute pyelonephritis during these 3 years. More than half the cases occurred in the second trimester of pregnancy, and 15% were readmitted because of re-infection. Overall, 68% of cases had positive urine cultures. The most frequently isolated organism (89.5%) was Escherichia coli, and 31% of the strains were resistant to ampicillin. We observed that the most frequent risk factor for pyelonephritis was asymptomatic bacteriuria/cystitis, although more than half the cases had been appropriately treated. Average in hospital stay was 4 days and no women developed sepsis. Moreover, there were no preterm births in this population, nor newborns weighing less than 2500 g.
Discussion – Acute pyelonephritis during pregnancy was relatively frequent in our institution, and the vast majority of women had no identifiable risk factors. Almost a third of Escherischia coli strains were resistant to ampicillin, therefore we recommend initial treatment with another antibiotics.
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