Revista Brasileira de Ginecologia e Obstetrícia (Aug 2012)
Resultados de dois esquemas de tratamento da pielonefrite durante a gravidez e correlação com o desfecho da gestação Results of two treatment regimens for pyelonephritis during pregnancy and correlation with pregnancy outcome
Abstract
OBJETIVO: Determinar o perfil epidemiológico das gestantes internadas por infecção do trato urinário, bem como verificar os agentes mais prevalentes e a resposta à antibioticoterapia. MÉTODOS: Estudo retrospectivo, que incluiu 106 gestantes internadas para tratamento de infecção do trato urinário no período entre janeiro de 2007 a dezembro de 2010. A avaliação constituiu-se de análise de prontuários dessas gestantes, observando-se informações sobre a internação e a gestação, bem como seu desfecho. Foi realizada a análise estatística por meio do programa Statistical Package for the Social Science, versão 15.0. Foram utilizados, para análise dos dados, o teste bilateral exato de Fisher e o teste t de Student, bem como métodos de estatística descritiva. RESULTADOS: Uroculturas positivas foram encontradas em 60,5% das gestantes internadas por infecção do trato urinário. O agente infeccioso mais frequente foi Escherichia coli e não houve diferença quanto à resistência, à recorrência ou a complicações entre os agentes etiológicos mais frequentes. Gestantes com infecção do trato urinário prévia tiveram maior risco de recorrência (OR=10,8; pPURPOSE: To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. METHODS: A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Student's t test were used for data analysis, as well as descriptive statistical methods. RESULTS: Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. CONCLUSION: In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.
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