{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T13:36:59Z","timestamp":1792503419344,"version":"4.5.0"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>\n            Objective\u2003Outside of pregnancy, urinary pathogens such as Proteus and Klebsiella are considered more pathogenic than E. coli. During pregnancy, the implications of lower urinary tract infection (LUTI) with more pathogenic bacteria are unclear. Thus, we sought to compare the risk of progression from LUTI to pyelonephritis among women infected with these more pathogenic urinary bacteria to those infected with E. coli.<\/jats:p><jats:p>\n            Study Design\u2003Retrospective cohort of pregnant women with LUTI at single tertiary center from July 2013 to May 2019. Pathogenic infections (PI) were defined as asymptomatic bacteriuria or acute cystitis urinary cultures positive for Proteus, Klebsiella, Enterobacter, Citrobacter, Acinetobacter, Staphylococcus, or Raoultella species. Demographic, infectious, antepartum, and postpartum data abstracted. Pregnant women with PI compared with those with E. coli. Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis length of stay (LOS) &gt;6 days, preterm birth (PTB), low birthweight (LBW), and measures of pyelonephritis-related morbidity.<\/jats:p><jats:p>\n            Results\u2003Of 686 pregnant women with LUTIs, 313 had urine culture growing out either PI or E. coli, with 59 (12%) growing PI and 254 (54%) growing E. coli. Women with PI were more likely to be African American, have chronic hypertension, and have history of preeclampsia. The primary species causing PI were Klebsiella (n\u2009=\u200929) and Proteus (n\u2009=\u200911). PI were not more likely to progress to pyelonephritis than E. coli LUTIs (10.9 vs. 14.5%; p\u2009=\u20090.67). Median LOS for pyelonephritis and other measures of pyelonephritis-related morbidity did not differ nor did PTB or LBW rates. After controlling for race, body mass index, history of preeclampsia, and history of pyelonephritis, PI were not associated with increased odds of progression to pyelonephritis (adjusted odds ratio: 0.69, 95% confidence interval: 0.27\u20131.80).<\/jats:p><jats:p>\n            Conclusion\u2003Bacteria traditionally considered to be more pathogenic outside of pregnancy do not progress to pyelonephritis at higher rates than E. coli in pregnancy, and are associated with similar pyelonephritis-related morbidity. Larger studies are needed to confirm these findings.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1717093","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T09:58:12Z","timestamp":1603792692000},"page":"473-478","source":"Crossref","is-referenced-by-count":4,"title":["Lower Urinary Pathogens: Do More Pathogenic Bacteria Increase the Risk of Pyelonephritis?"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4131-8563","authenticated-orcid":false,"given":"Heather A.","family":"Rosett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah; Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison K.","family":"Krischak","sequence":"additional","affiliation":[{"name":"Duke School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1204-3724","authenticated-orcid":false,"given":"Sarika","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Duke School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin E.","family":"Weaver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Phillips","family":"Heine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna E.","family":"Denoble","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K.","family":"Dotters-Katz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,9,24]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/S0889-8545(05)70219-9","article-title":"Urinary tract infections during pregnancy","volume":"28","author":"L C Gilstrap III","year":"2001","journal-title":"Obstet Gynecol Clin North Am"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"219.e1","DOI":"10.1016\/j.ajog.2013.10.006","article-title":"Acute pyelonephritis in pregnancy: an 18-year retrospective analysis","volume":"210","author":"D A Wing","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejogrb.2012.01.024","article-title":"Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes","volume":"162","author":"E Farkash","year":"2012","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1086\/427507","article-title":"Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults","volume":"40","author":"L E Nicolle","year":"2005","journal-title":"Clin Infect Dis"},{"issue":"01","key":"ref5","first-page":"W20-4","article-title":"Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement","volume":"149","author":"K Lin","year":"2008","journal-title":"Ann Intern Med"},{"key":"ref6","volume-title":"Obstetricians ACo, Gynecologists","author":"Pediatrics AAo","year":"2002"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"14S","DOI":"10.1016\/S0002-9343(02)01055-0","article-title":"The etiology of urinary tract infection: traditional and emerging pathogens","volume":"113","author":"A Ronald","year":"2002","journal-title":"Am J Med"},{"issue":"20","key":"ref8","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1056\/NEJMoa1302186","article-title":"Voided midstream urine culture and acute cystitis in premenopausal women","volume":"369","author":"T M Hooton","year":"2013","journal-title":"N Engl J Med"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1086\/519268","article-title":"Population-based epidemiologic analysis of acute pyelonephritis","volume":"45","author":"C A Czaja","year":"2007","journal-title":"Clin Infect Dis"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/01.AOG.0000149154.96285.a0","article-title":"Acute pyelonephritis in pregnancy","volume":"105","author":"J B Hill","year":"2005","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/AOG.0b013e3181809c0d","article-title":"ACOG practice bulletin no. 95: anemia in pregnancy","volume":"112","author":"American College of Obstetricians and Gynecologists","year":"2008","journal-title":"Obstet Gynecol"},{"key":"ref12","first-page":"780960","article-title":"The effects of anemia on pregnancy outcome in patients with pyelonephritis","volume":"2013","author":"S K Dotters-Katz","year":"2013","journal-title":"Infect Dis Obstet Gynecol"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1097\/AOG.0000000000003557","article-title":"Maternal and perinatal morbidity and mortality associated with anemia in pregnancy","volume":"134","author":"C Smith","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1038\/s41372-019-0375-0","article-title":"Maternal anemia and pregnancy outcomes: a population-based study","volume":"39","author":"R H Beckert","year":"2019","journal-title":"J Perinatol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1717093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T23:40:36Z","timestamp":1652485236000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1717093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,24]]},"references-count":14,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2022,5,13]]},"published-print":{"date-parts":[[2022,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1717093","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,24]]}}}