From the Guidelines
The prevalence of E. coli with beta-lactamase resistance is approximately 54.5%, the rate of preterm labor due to urinary tract infections (UTIs) is around 20-30%, and the prevalence of UTIs caused by E. coli is approximately 75-95%.
Prevalence of E. coli with Beta-Lactamase Resistance
The prevalence of E. coli with beta-lactamase resistance is a significant concern, as it affects the choice of antibiotic treatment. According to a study from Ireland, the likelihood of persistent resistance to amoxicillin-clavulanate is 54.5% 1. This highlights the need for alternative antibiotics such as nitrofurantoin, fosfomycin, or in more severe cases, carbapenems or aminoglycosides.
Rate of Preterm Labor due to UTIs
UTIs are associated with a significant risk of preterm labor, with studies indicating that untreated UTIs can increase the risk of preterm birth by 2-3 times compared to women without UTIs. Approximately 20-30% of pregnant women with untreated upper UTIs (pyelonephritis) may develop preterm labor 1. This connection exists because bacterial endotoxins can stimulate the production of cytokines and prostaglandins, which may trigger uterine contractions and cervical changes.
Prevalence of UTIs Caused by E. coli
E. coli is the predominant pathogen in urinary tract infections (UTIs), causing approximately 75-95% of uncomplicated UTIs in the general population 1. The high prevalence of E. coli in UTIs has important clinical implications, and regular urine screening during pregnancy is essential for early detection and treatment of UTIs to prevent complications including preterm labor.
Some key points to consider:
- The use of fluoroquinolones and cephalosporins should be avoided due to their propensity for collateral damage and the risk of promoting antibiotic resistance 1.
- Nitrofurantoin and beta-lactam antimicrobials are preferred for treating UTIs in pregnant women due to their safety profile, but their effectiveness may be limited by the high prevalence of beta-lactamase producing E. coli 1.
- Fosfomycin is an alternative antibiotic that can be used to treat UTIs, but its efficacy may be inferior to other available therapies 1.
From the FDA Drug Label
The study population consisted of patients with symptoms and signs of acute cystitis of less than 4 days duration, no manifestations of upper tract infection (e.g., flank pain, chills, fever), no history of recurrent urinary tract infections (20% of patients in the clinical studies had a prior episode of acute cystitis within the preceding year), no known structural abnormalities, no clinical or laboratory evidence of hepatic dysfunction, and no known or suspected CNS disorders, such as epilepsy, or other factors which would predispose to seizures Pathogen Fosfomycin 3 gram single-dose Ciprofloxacin 250 mg bid x 7 days Trimethoprim/sulfamethoxazole 160 mg/800 mg bid x 10 days Nitrofurantoin 100 mg bid x 7 days E coli 509/644 (79%) 184/187 (98%) 171/174 (98%) 146/187 (78%)
The prevalence of UTI due to E. coli is not directly stated in the provided text, but we can see the eradication rates of E. coli in the different treatment arms.
- Fosfomycin: 509/644 (79%)
- Ciprofloxacin: 184/187 (98%)
- Trimethoprim/sulfamethoxazole: 171/174 (98%)
- Nitrofurantoin: 146/187 (78%) However, the prevalence of E. coli with beta-lactamase resistance and the rate of preterm labor due to UTI are not mentioned in the provided text. The FDA drug label does not answer the question.
From the Research
Prevalence of E. coli with Beta-Lactamase Resistance
- The prevalence of E. coli with beta-lactamase resistance is not directly stated in the provided studies, but study 2 mentions that 83.5% of quinolone-resistant E. coli isolates were resistant to amoxicillin, which is a beta-lactam antibiotic.
- Study 3 reports that 70.6% of E. coli isolates were resistant to ceftriaxone, a third-generation cephalosporin that is often used to treat beta-lactamase-producing bacteria.
Rate of Preterm Labor due to UTI
- Study 4 mentions that untreated UTIs can lead to preterm labor, but does not provide a specific rate.
- Study 5 reports that the probability of delivering premature infants was significantly higher among women who experienced UTIs during pregnancy, with UTI being one of the main contributors to preterm deliveries.
- Study 6 found no significant difference in adverse obstetric outcomes, including preterm labor, between women with ESBL-E-positive urine cultures and those with non-ESBL-E-positive urine cultures.
Prevalence of UTI due to E. coli
- Study 3 reports that E. coli was the most frequent (43.2%) of the organisms implicated in bacteriuria among pregnant women with UTIs.
- Study 4 mentions that UTIs occur in about 8% of pregnant women, but does not provide a specific prevalence of E. coli as the causative agent.
- Study 5 reports that the incidence of UTIs during pregnancy was 31.3%, with E. coli being one of the most common organisms isolated.