Robert J Stiller, MD, Christopher Hicks, MD, and Zane Saul, MD
Dr Stiller is Chief, Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Bridgeport Hospital, Bridgeport, Connecticut, and Clinical Professor of Obstetrics and Gynecology, Yale University School of Medicine.
Dr Hicks is Resident in the Department of Obstetrics and Gynecology, Bridgeport Hospital, Bridgeport, Connecticut.
Dr Saul is Chief, Section of Infectious Disease, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut, and Clinical Instructor of Medicine, Yale University School of Medicine.
None of the authors has a conflict of interest to report in respect to the content of this article.
Ob/gyns have witnessed how development of antibiotic resistance has affected disease management in our specialty. Increased resistance of Neisseria gonorrhea (N gonorrhea) to penicillins and quinolones, emergence of methicillin-resistant staphylococcus aureus (MRSA) and resistance of Group B Streptococcus to erythromycin and clindamycin have led us to modify our antibiotic treatment regimens. Whether antibiotics are appropriately or inappropriately prescribed, they can lead to loss of effectiveness by allowing only organisms with resistance to survive and multiply in a process similar to natural selection. Alternatively, organisms can share genetic information through plasmids, which are small segments of DNA that can code for production of resistance factors.
Urinary tract infections (UTIs) complicate 3% to 10% of pregnancies and are among the most common reasons for antibiotic use in obstetrics.1 Clinically relevant disease may include lower urinary tract conditions such as asymptomatic bacteriuria and acute cystitis or upper tract urinary infections such as pyelonephritis. In pregnancy, these infections are most frequently caused by the Enterobacteriaceae group of organisms, which include the gram negative rods, Escherichia coli (E coli) (82.5%), Klebsiella pneumoniae (K pneumoniae) (7.6%), Proteus mirabilis (4.9%), and Enterobacter species (5.7%). Gram positive organisms such as Streptococcus species (21.4%), Staphylococcus species (6.5%), and Enterococcus species (5.7%) also cause infections, although frequencies of specific organisms vary among case series.2