Hill James B, Sheffield Jeanne S, McIntire Donald D, Wendel George D
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9032, USA.
Obstet Gynecol. 2005 Jan;105(1):18-23. doi: 10.1097/01.AOG.0000149154.96285.a0.
To examine the incidence of pyelonephritis and the incidence of risk factors, microbial pathogens, and obstetric complications in women with acute antepartum pyelonephritis.
For 2 years, information on pregnant women with acute pyelonephritis was collected in a longitudinal study. All women were admitted to the hospital and treated with intravenous antimicrobial agents. We compared the pregnancy outcomes of these women with those of the general obstetric population received at our hospital during the same time period.
Four hundred forty cases of acute antepartum pyelonephritis were identified during the study period (incidence 1.4%). Although there were no significant differences in ethnicity, pyelonephritis was associated with nulliparity (44% versus 37%, P = .003) and young age (P = .003). Thirteen percent of the women had a known risk factor for pyelonephritis. Acute pyelonephritis occurred more often in the second trimester (53%), and the predominant uropathogens were Escherichia coli (70%) and gram-positive organisms, including group B beta Streptococcus (10%). Complications included anemia (23%), septicemia (17%), transient renal dysfunction (2%), and pulmonary insufficiency (7%).
The incidence of pyelonephritis has remained low in the era of routine prenatal screening for asymptomatic bacteriuria. First-trimester pyelonephritis accounts for over 1 in 5 antepartum cases. Gram-positive uropathogens are found more commonly as pregnancy progresses. Maternal complications continue, but poor obstetrical outcomes are rare.
研究急性产前肾盂肾炎女性患者的肾盂肾炎发病率、危险因素发生率、微生物病原体及产科并发症发生率。
在一项纵向研究中，收集了2年期间患有急性肾盂肾炎孕妇的信息。所有女性均入院并接受静脉抗菌药物治疗。我们将这些女性的妊娠结局与同期在我院接受治疗的普通产科人群的妊娠结局进行了比较。
在研究期间共确诊440例急性产前肾盂肾炎病例（发病率1.4%）。尽管种族方面无显著差异，但肾盂肾炎与初产（44%对37%，P = .003）和年轻年龄（P = .003）相关。13%的女性有已知的肾盂肾炎危险因素。急性肾盂肾炎在孕中期更为常见（53%），主要的尿路病原体为大肠杆菌（70%）和革兰氏阳性菌，包括B族链球菌（10%）。并发症包括贫血（23%）、败血症（17%）、短暂性肾功能不全（2%）和肺功能不全（7%）。
在无症状菌尿症常规产前筛查时代，肾盂肾炎的发病率仍然较低。孕早期肾盂肾炎占产前病例的五分之一以上。随着妊娠进展，革兰氏阳性尿路病原体更为常见。母亲并发症持续存在，但不良产科结局罕见。
