目的妊娠合并下尿路B族链球菌(GBS)定植与绒毛膜羊膜炎等严重感染相关,子宫内膜炎,和肾盂肾炎.这项研究的目的是比较GBS和大肠杆菌下尿路感染(LUTIs)之间肾盂肾炎的进展率,以及比较这些病原体继发的传染病和产科发病率。研究设计回顾性队列研究2013年7月至2019年5月期间来自单一卫生系统的LUTI(无症状细菌或急性膀胱炎[AC])孕妇。人口统计,传染性,产前,从GBS或大肠杆菌LUTI患者的病历中提取产时数据.主要结果是进展为肾盂肾炎。次要结果包括肾盂肾炎相关性贫血,脓毒症,肾盂肾炎住院时间(LOS),分娩时的中位胎龄(GA),早产,低出生体重(LBW)。使用Logistic回归计算主要结局的调整后几率。结果729例孕妇尿路定植,433对上述细菌之一培养呈阳性,其中189(43.6%)具有GBS和244(56.4%)具有大肠杆菌。患有大肠杆菌的女性更可能更年轻,使用烟草,有AC的历史,有早产史.与GBS(1.1%;p<0.001)相比,大肠杆菌(15.6%)进展为肾盂肾炎的速率明显更高。肾盂肾炎和肾盂肾炎相关疾病的中位LOS没有差异。交货时GA中位数,早产,和LBW率也没有差异。在调整后的分析中,控制AC的历史,保险状况,烟草使用,先前的早产,原发感染类型,和产妇年龄,与大肠杆菌组相比,GBSLUTI组孕妇发生肾盂肾炎的几率显著降低(校正比值比:0.04,95%置信区间:0.01~0.28).结论妊娠合并大肠埃希菌感染进展为肾盂肾炎的发生率明显高于GBS,尽管产科结局相似。
Objective Group B Streptococcus (GBS) colonization of the lower urinary tract in pregnancy is associated with severe infections such as chorioamnionitis, endometritis, and pyelonephritis. The objective of this study was to compare rates of progression to pyelonephritis between GBS and Escherichia coli lower urinary tract infections (LUTIs), as well as compare infectious and obstetric morbidity secondary to these pathogens. Study Design Retrospective cohort of pregnant women with LUTIs (asymptomatic bacteria or acute cystitis [AC]) from a single health system between July 2013 and May 2019. Demographic, infectious, antepartum, and intrapartum data were abstracted from medical records of women with GBS or E. coli LUTI. The primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, pyelonephritis length of stay (LOS), median gestational age (GA) at delivery, preterm delivery, and low birth weight (LBW). Logistic regression was used to calculate the adjusted odds of the primary outcome. Results Of 729 pregnant women with urinary colonization, 433 were culture positive for one of the aforementioned bacteria, with 189 (43.6%) having GBS and 244 (56.4%) having E. coli. Women with E. coli were more likely to be younger, use tobacco, have a history of AC, and have a history of preterm birth. Rates of progression to pyelonephritis were markedly higher with E. coli (15.6%) than with GBS (1.1%; p < 0.001). Median LOS for pyelonephritis and pyelonephritis-related morbidities did not differ. Median GA at delivery, preterm delivery, and LBW rates also did not differ. In adjusted analysis, controlling for history of AC, insurance status, tobacco use, prior preterm birth, primary infection type, and maternal age, women with GBS LUTI had markedly decreased odds of developing pyelonephritis in pregnancy compared with those with E. coli (adjusted odds ratio: 0.04, 95% confidence interval: 0.01-0.28). Conclusion Escherichia coli infections progress to pyelonephritis in pregnancy at markedly higher rates than GBS, although obstetric outcomes are similar.