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Management of Antibiotic-Resistant Acute Pyelonephritis
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Ha Na Lee, Hana Yoon
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Urogenit Tract Infect 2017;12(3):95-102. Published online December 31, 2017
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 Abstract
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- Acute pyelonephritis (APN) is a common urinary tract infection that affects a large proportion of women. Although antimicrobial therapy is a successful treatment in most cases, empirically, antibiotic resistance has emerged as a serious issue, including high resistance rate of fluoroquinolone and the advent of extended-spectrum β-lactamase (ESBL)-producing organisms. Several agents can be considered for the management of antibiotic resistant APN. Fosfomycin trometamol is effective in treating ESBL-producing bacterial infection. Oral trimethoprim/sulfamethoxazole, β-lactam agents, such as cephalosporin, and fluoroquinolone can be regarded as appropriate agents if pathogen is susceptible. Carbapenem, such as imipenem, meropenem, and doripenem, is one of the best and widely used agents for treating antibiotic resistant APN. However, there have recently been concerns regarding the increased rates of resistance to carbapenems. Daptomycin, linezolid, and tigecycline can be considered as solutions to antibiotic resistant organisms. Antibiotic resistant APN should be treated as other systemic infections to prevent antibiotic overuse with proper treatment duration considering carbapenem-saving strategy.
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Urinary Tract Infections in Pregnancy
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Bong Suk Shim, Mi Mi Oh, Young-suk Lee, Ha Na Lee
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):155-164. Published online October 31, 2011
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Abstract
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- Urinary tract infections (UTIs) are more common during pregnancy because of changes in the urinary tract. Symptomatic UTI occurs in 1% to 2% of pregnancies, while asymptomatic bacteriuria has been reported in 2% to 11% of pregnant women. UTIs during pregnancy can lead to serious consequences if left untreated. Asymptomatic bacteriuria is associated with an increased risk of pyelonephritis and adverse outcomes of pregnancy. Therefore, antepartum screening is recommended to detect asymptomatic bacteriuria in pregnancy. Oral antibiotics are the treatment of choice for asymptomatic bacteriuria and cystitis. Antibiotic agent is selected by drug safety concerns and urine culture susceptibility data. The standard course of treatment for pyelonephritis is hospital admission and intravenous antibiotics. Antibiotic prophylaxis is indicated in some cases. Prompt treatment of symptomatic UTIs and asymptomatic bacteriuria is warranted in pregnant women.
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