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19: Extended spectrum beta-lactamase urinary tract infections during pregnancy
IDSOG Abstracts
ajog.org
Table Delivery and survival data for women with preterm premature rupture of membranes with singleton compared to twin pregnancy (2000-2015)
Median GA @ ROM Median Latency (wks) IQR GA @ delivery
Singleton n¼82
Multiple n¼22
20.6 (18.7, 22.1)
20.5 (18.7, 21.9)
0.92
2 (0.6, 4.6)
1.5 (0.6, 4.3)
0.87
23.1 (20.4, 23.6)
0.80
22.8 (20.6, 25)
p-value
Chorioamnionitis as delivery indication
30 (37)
13 (59)
0.06
Delivery before 23 weeks
44 (54)
10 (45)
0.49
Survival*
26 (32)
12 (55)
0.048
*Survival of at least one infant to discharge from NICU/hospital, entire cohort.
neonatal morbidity and/or death (63 vs 50%, p¼0.41). However, survival to hospital discharge of at least one infant (68 vs 100%, p¼0.03) more common in twin gestation. CONCLUSIONS: Initial neonatal outcomes following previable PPROM are poor with high rates of chorioamnionitis. The majority of both twins and singletons delivered prior to viability (23 weeks). For those pregnancies that continue to 23 weeks, neonatal morbidity and mortality was high, though survival of at least one infant may be more likely in twins.
department clinic (18.2% versus 9.0%) and less likely to be diagnosed in a private physician office (0% versus 28.0%) compared with women classified as missed opportunities (p¼0.01). CONCLUSIONS: The majority of CS cases were preventable and resulted from failure of the healthcare system or inability of women to access prenatal care and testing. Differences in place of diagnosis may indicate acute care settings that would benefit from additional training and support in syphilis case reporting, treatment and patient education.
18 Characteristics of and factors contributing to congenital syphilis cases in georgia: 2000-2009
19 Extended spectrum beta-lactamase urinary tract infections during pregnancy
A. Kachikis1, M. A. Schiff1, T. Chapple-McGruder2, J. Arluck3
B. Kelly, M. Beninati, C. Davidson, S. L. Clark, C. S. Eppes
1
Geisinger Medical Center Danville, PA
University of Washington, Seattle, WA, 2Essence of Public Health, Atlanta, GA, 3Emory University, Atlanta, GA
OBJECTIVES: The study’s objectives were to examine characteristics of
congenital syphilis (CS) cases in the state of Georgia from 2000 e 2009 and to compare socio-demographic factors and birth outcomes among women who did and did not utilize the healthcare system during pregnancy. METHODS: This study was a secondary data analysis of CS cases within Georgia from 2000 - 2009 reported on the CDC Congenital Syphilis Case Investigation and Reporting Form. Data included mother’s race and marital status, rural or urban location, number of prenatal visits, place of diagnosis, infant gestational age and weight at birth, whether the child was treated, and the final disease classification for the infant. Women who did access the health care system through prenatal care were classified as missed opportunities for preventing CS during pregnancy. Women who had no prenatal care were classified as those not accessing the healthcare system. Statistical analyses were performed to compare these groups using chi-square tests. RESULTS: From 2000-2009, 101 reported cases of presumptive CS were found. One was classified as a confirmed case, two were syphilitic stillbirths and 98 were presumptive cases. Over 61% were born to Black non-Hispanic women, 14.8% to white non-Hispanic, 22.8% to Hispanic and 1% to Asian/Alaskan native women. Most women were unmarried (82.1%), lived in urban areas (86.1%), and reported receiving prenatal care (77.3%). Infants in 64.4% of these cases were born at term and 66.7% weighed greater than 2500g at birth. Of the 101 cases, 72.3% were defined as missed opportunities within the healthcare system and 21.8% did not utilize the healthcare system. Women not accessing the healthcare system were more likely to be diagnosed in a hospital (81.8% versus 62.7%) or a health
OBJECTIVES: Extended spectrum beta-lactamases (ESBLs) are enzymes produced by gram-negative bacilli that result in resistance against most antibiotics. We sought to evaluate the epidemiology and impact of ESBL urinary tract infections (UTIs) during pregnancy. METHODS: We performed a case control study comparing outcomes in pregnant women with optimally treated ESBL UTIs, sub-optimally treated ESBL UTIs, and non-ESBL UTIs from 2012-2014. Suboptimal treatment was defined as treatment without carbapenems or post-treatment negative urine culture. For those with ESBL UTIs, we identified antecedent infections, prior antibiotic use, and the treatment course. RESULTS: 457 reproductive age female patients with ESBL UTIs were identified, of whom 13% (n¼60) were pregnant. Of these, 45 had pregnancy outcome data. Suboptimal treatment was noted in the majority of cases involving ESBL UTI (89%, n¼40), which was far more likely than what was observed for non-ESBL infections. 12 out of 13 cases of ESBL pyelonephritis arose surrounding suboptimal treatment, as opposed to 1 out of 21 cases of non-ESBL pyelonephritis (p¼0.001). 21 of 287 women with non-ESBL UTI developed pyelonephritis, compared to 13 of 45 women with ESBL UTIs (p¼0.001). One case of pyelonephritis, chorioamnionitis, wound infection, sepsis bacteremia or necrotizing fasciitis was noted in the optimally treated ESBL group, while 14 such outcomes occurred in the group without optimal treatment. CONCLUSIONS: Sub-optimal treatment of ESBL infections in pregnancy is common. Our data support the importance of more aggressive treatment and follow up of pregnant women with ESBL UTIs to prevent secondary clinical pyelonephritis. DECEMBER 2016 American Journal of Obstetrics & Gynecology
835
ajog.org
Table Delivery and survival data for women with preterm premature rupture of membranes with singleton compared to twin pregnancy (2000-2015)
Median GA @ ROM Median Latency (wks) IQR GA @ delivery
Singleton n¼82
Multiple n¼22
20.6 (18.7, 22.1)
20.5 (18.7, 21.9)
0.92
2 (0.6, 4.6)
1.5 (0.6, 4.3)
0.87
23.1 (20.4, 23.6)
0.80
22.8 (20.6, 25)
p-value
Chorioamnionitis as delivery indication
30 (37)
13 (59)
0.06
Delivery before 23 weeks
44 (54)
10 (45)
0.49
Survival*
26 (32)
12 (55)
0.048
*Survival of at least one infant to discharge from NICU/hospital, entire cohort.
neonatal morbidity and/or death (63 vs 50%, p¼0.41). However, survival to hospital discharge of at least one infant (68 vs 100%, p¼0.03) more common in twin gestation. CONCLUSIONS: Initial neonatal outcomes following previable PPROM are poor with high rates of chorioamnionitis. The majority of both twins and singletons delivered prior to viability (23 weeks). For those pregnancies that continue to 23 weeks, neonatal morbidity and mortality was high, though survival of at least one infant may be more likely in twins.
department clinic (18.2% versus 9.0%) and less likely to be diagnosed in a private physician office (0% versus 28.0%) compared with women classified as missed opportunities (p¼0.01). CONCLUSIONS: The majority of CS cases were preventable and resulted from failure of the healthcare system or inability of women to access prenatal care and testing. Differences in place of diagnosis may indicate acute care settings that would benefit from additional training and support in syphilis case reporting, treatment and patient education.
18 Characteristics of and factors contributing to congenital syphilis cases in georgia: 2000-2009
19 Extended spectrum beta-lactamase urinary tract infections during pregnancy
A. Kachikis1, M. A. Schiff1, T. Chapple-McGruder2, J. Arluck3
B. Kelly, M. Beninati, C. Davidson, S. L. Clark, C. S. Eppes
1
Geisinger Medical Center Danville, PA
University of Washington, Seattle, WA, 2Essence of Public Health, Atlanta, GA, 3Emory University, Atlanta, GA
OBJECTIVES: The study’s objectives were to examine characteristics of
congenital syphilis (CS) cases in the state of Georgia from 2000 e 2009 and to compare socio-demographic factors and birth outcomes among women who did and did not utilize the healthcare system during pregnancy. METHODS: This study was a secondary data analysis of CS cases within Georgia from 2000 - 2009 reported on the CDC Congenital Syphilis Case Investigation and Reporting Form. Data included mother’s race and marital status, rural or urban location, number of prenatal visits, place of diagnosis, infant gestational age and weight at birth, whether the child was treated, and the final disease classification for the infant. Women who did access the health care system through prenatal care were classified as missed opportunities for preventing CS during pregnancy. Women who had no prenatal care were classified as those not accessing the healthcare system. Statistical analyses were performed to compare these groups using chi-square tests. RESULTS: From 2000-2009, 101 reported cases of presumptive CS were found. One was classified as a confirmed case, two were syphilitic stillbirths and 98 were presumptive cases. Over 61% were born to Black non-Hispanic women, 14.8% to white non-Hispanic, 22.8% to Hispanic and 1% to Asian/Alaskan native women. Most women were unmarried (82.1%), lived in urban areas (86.1%), and reported receiving prenatal care (77.3%). Infants in 64.4% of these cases were born at term and 66.7% weighed greater than 2500g at birth. Of the 101 cases, 72.3% were defined as missed opportunities within the healthcare system and 21.8% did not utilize the healthcare system. Women not accessing the healthcare system were more likely to be diagnosed in a hospital (81.8% versus 62.7%) or a health
OBJECTIVES: Extended spectrum beta-lactamases (ESBLs) are enzymes produced by gram-negative bacilli that result in resistance against most antibiotics. We sought to evaluate the epidemiology and impact of ESBL urinary tract infections (UTIs) during pregnancy. METHODS: We performed a case control study comparing outcomes in pregnant women with optimally treated ESBL UTIs, sub-optimally treated ESBL UTIs, and non-ESBL UTIs from 2012-2014. Suboptimal treatment was defined as treatment without carbapenems or post-treatment negative urine culture. For those with ESBL UTIs, we identified antecedent infections, prior antibiotic use, and the treatment course. RESULTS: 457 reproductive age female patients with ESBL UTIs were identified, of whom 13% (n¼60) were pregnant. Of these, 45 had pregnancy outcome data. Suboptimal treatment was noted in the majority of cases involving ESBL UTI (89%, n¼40), which was far more likely than what was observed for non-ESBL infections. 12 out of 13 cases of ESBL pyelonephritis arose surrounding suboptimal treatment, as opposed to 1 out of 21 cases of non-ESBL pyelonephritis (p¼0.001). 21 of 287 women with non-ESBL UTI developed pyelonephritis, compared to 13 of 45 women with ESBL UTIs (p¼0.001). One case of pyelonephritis, chorioamnionitis, wound infection, sepsis bacteremia or necrotizing fasciitis was noted in the optimally treated ESBL group, while 14 such outcomes occurred in the group without optimal treatment. CONCLUSIONS: Sub-optimal treatment of ESBL infections in pregnancy is common. Our data support the importance of more aggressive treatment and follow up of pregnant women with ESBL UTIs to prevent secondary clinical pyelonephritis. DECEMBER 2016 American Journal of Obstetrics & Gynecology
835