Limited clinical utility of blood and urine cultures in the treatment of acute pyelonephritis during pregnancy

• Published in: American journal of obstetrics and gynecology 2000-06, Vol.182 (6), p.1437-1441
• Main Authors: Wing, Deborah A., Park, Alane S., DeBuque, Laurie, Millar, Lynnae K.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the urinary system; Bacterial Infections; Biological and medical sciences; Blood - microbiology; Blood culture; Cost-Benefit Analysis; Drug Resistance, Microbial; Escherichia coli - isolation & purification; Escherichia coli - physiology; Escherichia coli Infections; Female; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Microbiological Techniques - economics; Microbiological Techniques - standards; Pregnancy; Pregnancy Complications, Infectious - blood; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - microbiology; Pregnancy Complications, Infectious - urine; pyelonephritis; Pyelonephritis - blood; Pyelonephritis - drug therapy; Pyelonephritis - microbiology; Pyelonephritis - urine; Randomized Controlled Trials as Topic; Sensitivity and Specificity; Urine - microbiology; urine culture
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1067/mob.[phone]

Objective: The purpose of this study was to determine the utility of urine and blood cultures in the clinical management of pregnant women with acute pyelonephritis. Study Design: Data were pooled from three randomized controlled trials that were conducted at two university-based tertiary care centers and included 391 pregnant women with pyelonephritis. The results of urine and blood cultures were correlated with clinical management decisions, outcome, length of hospital stay, and cost. Results: Results of 98% of urine cultures (382/391) and 99% of blood cultures (388/391) were available for analysis. The most common pathogen isolated was Escherichia coli, which was found in 79% of the urine cultures (300/382) and in 77% of the blood cultures (27/35). Susceptibility testing revealed 46% resistance to ampicillin; 7%, 2%, and 0% resistances to first-, second-, and third-generation cephalosporins, respectively; and 1% resistance to gentamicin. Six percent of the participants (25/391) required changes in antibiotic therapy, most commonly for persistent fever (6/25, 25%). Positive blood culture results directly influenced management by prolonging the duration of hospitalization, with means of 4.6 ± 2.6 hospital days for women with bacteremia and 2.6 ± 1.5 hospital days for women without bacteremia (P