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    Byron D. Elliott, M.D. Medical Director of Perinatology Seton Medical Center

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    champ1909
    Pyelonephritis, or kidney infection, occurs in 1-2.5% of pregnancies and can recur in 10-18% of cases if left untreated. Risk factors include urinary tract anomalies and infections. It is typically caused by E. coli and presents with fever, flank pain, and urinary symptoms. Treatment involves hospitalization, intravenous fluids and antibiotics, with mild cases receiving oral antibiotics afterwards. For severe infections, organ support may be needed and tocolytic drugs should be used cautiously to prevent premature labor if indicated. Preventing and treating asymptomatic bacteriuria can reduce the risk of pyelonephritis during pregnancy.

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    Byron D. Elliott, M.D. Medical Director of Perinatology Seton Medical Center

    Uploaded by

    champ1909
    78 views16 pages
    Pyelonephritis, or kidney infection, occurs in 1-2.5% of pregnancies and can recur in 10-18% of cases if left untreated. Risk factors include urinary tract anomalies and infections. It is typically caused by E. coli and presents with fever, flank pain, and urinary symptoms. Treatment involves hospitalization, intravenous fluids and antibiotics, with mild cases receiving oral antibiotics afterwards. For severe infections, organ support may be needed and tocolytic drugs should be used cautiously to prevent premature labor if indicated. Preventing and treating asymptomatic bacteriuria can reduce the risk of pyelonephritis during pregnancy.

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    Pyelonephritis

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    Pyelonephritis

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    Pyelonephritis, or kidney infection, occurs in 1-2.5% of pregnancies and can recur in 10-18% of cases if left untreated. Risk factors include urinary tract anomalies and infections. It is typically caused by E. coli and presents with fever, flank pain, and urinary symptoms. Treatment involves hospitalization, intravenous fluids and antibiotics, with mild cases receiving oral antibiotics afterwards. For severe infections, organ support may be needed and tocolytic drugs should be used cautiously to prevent premature labor if indicated. Preventing and treating asymptomatic bacteriuria can reduce the risk of pyelonephritis during pregnancy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    78 views16 pages

    Byron D. Elliott, M.D. Medical Director of Perinatology Seton Medical Center

    Uploaded by

    champ1909
    Pyelonephritis, or kidney infection, occurs in 1-2.5% of pregnancies and can recur in 10-18% of cases if left untreated. Risk factors include urinary tract anomalies and infections. It is typically caused by E. coli and presents with fever, flank pain, and urinary symptoms. Treatment involves hospitalization, intravenous fluids and antibiotics, with mild cases receiving oral antibiotics afterwards. For severe infections, organ support may be needed and tocolytic drugs should be used cautiously to prevent premature labor if indicated. Preventing and treating asymptomatic bacteriuria can reduce the risk of pyelonephritis during pregnancy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 16

    Byron D. Elliott, M.D.

    Medical Director of Perinatology Seton Medical Center

    Pyelonephritis in Pregnancy Incidence


    Occurs more commonly than any other medical problem in pregnancy Overall incidence is 1 - 2.5% in those receiving UNIVERSAL SCREENING and treatment of asymptomatic bacteriuria (ASB) As high as 40% of pregnancies with untreated ASB will develop pyelonephritis

    Pyelonephritis in Pregnancy Recurrence Risk

    Risk of recurrence in same pregnancy as high as 10 -18% with suppressive therapy Recurrence as high as 60% if ongoing suppressive therapy is not employed

    Pyelonephritis in Pregnancy Predisposing Factors

    Physiologic changes of pregnancy:


    Hydronephrosis, vesicoureteral reflux Increased bladder capacity, incomplete

    emptying Increased urine pH during pregnancy

    Coexistent factors:

    Urinary anomalies, calculi, multiple UTIs Dehydration, poor hygiene Resistant organisms, Rx noncompliance Diabetes, Sickle disease

    Pyelonephritis in Pregnancy Diagnostic Criteria

    Clinical Findings:

    Fever, chills, malaise CVA pain/tenderness, dysuria, frequency 50% unilateral right sided flank pain 25% bilateral or unilateral left sided pain
    Pyuria, bacteriuria White blood cell casts highly predictive Positive urine culture 10 20% bacteremic

    Laboratory Findings:

    Pyelonephritis in Pregnancy Disease Categorization


    Mild / Moderate Low-grade Fever Normal or slightly elevated white blood cell count Absence of Nausea or Vomiting

    Outpatient management after inpatient observation and initial parenteral Rx. can be considered with 14 day oral antibiotic therapy

    Severe High Fever Respiratory Insufficiency Poor urine output Sepsis Unable to tolerate oral intake or antibiotics No improvement during initial / observational phase

    Inpatient management is required

    Pyelonephritis in Pregnancy Common pathogens


    Escherichia coli 70 80% Klebsiella sp 3 7.4% Staph aureus 6.7% Proteus mirablis 2% Gram positive (includes GBS) 10%

    Pyelonephritis in Pregnancy Initial Management

    Inpatient observation Intravenous hydration, Lactated Ringers Strict I & O, Maintain output >30-50cc/hr Parenteral antibiotics Laboratory / Diagnostic Tests:
    CBC, electrolytes, creatinine, urinalysis,

    urine culture and sensitivities CXR, pulse oximetry, ABGs if respiratory symptoms present

    Pyelonephritis in Pregnancy Antibiotic Alternatives

    Parenteral
    Ceftriaxone
    Cefotetan Cefotaxime

    Ampicillin and

    Gentamycin Ampicillin/Sulbactam Piperacillin/Tazobactam

    1-2gm q 24h 2gm q 12h 1-2gm q 8h 2gm q 6h 3-5mg/kg/day 1.5gm q 6h 3.75gm q 6-8h

    Pyelonephritis in Pregnancy Antibiotic alternatives

    Oral
    Amoxicillin/Clavulanate
    Bactrim DS

    875/125mg BID 160/800mg BID

    Suppression post-treatment
    Nitrofurantoin

    100mg hs

    Pyelonephritis in Pregnancy Complications

    Multi-organ system involvement in 20% Anemia due to hemolysis in up to 66% DIC with severe sepsis Transient renal dysfunction in 20% ARDS in 2 8%, especially with:

    Tachycardia >110 BPM Fever >103 in first 24 hours Fluid overload Tocolytic therapy

    Preterm Labor

    Pyelonephritis in Pregnancy Preterm Labor

    Treatment of Preterm labor in pyelonephritis with tocolytic therapy and steroids should be undertaken with great caution. Only for documented cervical change and regular uterine contractions unresponsive to hydration and parenteral antibiotics. Withholding tocolytics and/or steroids is appropriate in certain circumstances in patients with respiratory or hemodynamic instability.

    Pyelonephritis in Pregnancy First Trimester Considerations

    Aggressive treatment with:


    Cooling blanket
    Acetaminophen

    Maintain lower core temperature secondary to increased risk of fetal anomalies in high fever scenario

    Pyelonephritis in Pregnancy Summary of Management

    Preventative Measures:
    Universal screening for ASB Treatment of ASB

    Initial Treatment:

    In-hospital observation for 24h Parenteral antibiotics Laboratory work-up Hydration to maintain urine output >30-50cc/hr Strict I & O CXR, ABG, Oximetry if respiratory symptoms present

    Pyelonphritis in Pregnancy Summary of Management

    Mild/Moderate Pyelonephritis:

    Initial hospital observation and work-up Parenteral antibiotics until discharge 14 day course of oral antibiotics Test of cure
    Inpatient management Parenteral antibiotics Strict fluid management Support of secondary organ system involvement

    Severe Pyelonephritis

    Pyelonephritis in pregnancy Preterm Labor

    Tocolytics only when clearly indicated by cervical change, and uterine contractions not resolved by hydration and antibiotic therapy

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