Gomi Harumi, Goto Yoshihito, Laopaiboon Malinee, Usui Rie, Mori Rintaro
Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, Japan, 310-0015.
Cochrane Database Syst Rev. 2015 Feb 13;2015(2):CD009216. doi: 10.1002/14651858.CD009216.pub2.
Pyelonephritis is a type of urinary tract infection (UTI) that affects the upper urinary tract and kidneys, and is one of the most common conditions for hospitalisation among pregnant women, aside from delivery. Samples of urine and blood are obtained and used for cultures as part of the diagnosis and management of the condition. Acute pyelonephritis requires hospitalisation with intravenous administration of antimicrobial agents. Several studies have questioned the necessity of obtaining blood cultures in addition to urine cultures, citing cost and questioning whether blood testing is superfluous. Pregnant women with bacteraemia require a change in the initial empirical treatment based on the blood culture. However, these cases are not common, and represent approximately 15% to 20% of cases. It is unclear whether blood cultures are essential for the effective management of the condition.
To assess the effectiveness of routine blood cultures to improve health outcomes in the management of pyelonephritis in pregnant women.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register without language or date restrictions (31 December 2014).
Randomised controlled trials and quasi-randomised trials comparing outcomes among pregnant women with pyelonephritis who received initial management with or without blood cultures. Cluster-randomised trials were eligible for inclusion in this review but none were identified. Clinical trials using a cross-over design were not eligible for inclusion.
Two review authors independently assessed one trial report for inclusion.
We identified one trial report but this was excluded. No clinical trials met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS: There are no large-scale randomised controlled trials to assess outcomes in the management of pyelonephritis in pregnancy with or without blood cultures. Randomised controlled trials are needed to evaluate the effectiveness of managing pyelonephritis in pregnant women with or without blood cultures, and to assess any adverse outcomes as well as the cost-effectiveness of excluding blood cultures from treatment.
肾盂肾炎是一种影响上尿路和肾脏的尿路感染（UTI），是孕妇除分娩外最常见的住院原因之一。作为该疾病诊断和管理的一部分，会采集尿液和血液样本用于培养。急性肾盂肾炎需要住院并静脉注射抗菌药物。几项研究对除尿液培养外进行血培养的必要性提出质疑，理由是成本问题，并质疑血液检测是否多余。患有菌血症的孕妇需要根据血培养结果改变初始经验性治疗方案。然而，这些病例并不常见，约占病例的15%至20%。目前尚不清楚血培养对于该疾病的有效管理是否至关重要。
评估常规血培养对改善孕妇肾盂肾炎管理中健康结局的有效性。
我们检索了Cochrane妊娠与分娩组试验注册库，无语言或日期限制（截至2014年12月31日）。
比较接受初始管理时进行或未进行血培养的孕妇肾盂肾炎结局的随机对照试验和半随机试验。整群随机试验符合纳入本综述的条件，但未检索到。采用交叉设计的临床试验不符合纳入条件。
两位综述作者独立评估一份试验报告以确定是否纳入。
我们确定了一份试验报告，但将其排除。没有临床试验符合本综述的纳入标准。
尚无大规模随机对照试验评估有或无血培养情况下孕妇肾盂肾炎管理的结局。需要进行随机对照试验来评估有或无血培养情况下管理孕妇肾盂肾炎的有效性，评估任何不良结局以及将血培养排除在治疗之外的成本效益。
