{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:48:23Z","timestamp":1776098903714,"version":"3.50.1"},"reference-count":22,"publisher":"Federacion Colombiana de Obstetricia y Ginecologia","issue":"1","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100002753","name":"Universidad Nacional de Colombia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002753","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002753","name":"Universidad Nacional de Colombia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002753","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["revista.fecolsog.org"],"crossmark-restriction":false},"short-container-title":["Rev. colomb. obstet. ginecol."],"abstract":"<jats:p>Objetivos: generar recomendaciones informadas en la evidencia, a trav\u00e9s de un consenso formal, orientadas al tratamiento de la infecci\u00f3n de v\u00edas urinarias altas durante la gestaci\u00f3n.Materiales y m\u00e9todos: en el grupo desarrollador participaron expertos tem\u00e1ticos en microbiolog\u00eda, salud p\u00fablica, medicina interna, infectolog\u00eda, obstetricia, medicina materno-fetal e infectolog\u00eda ginecobst\u00e9t r ica. Tambi\u00e9n hicieron par te profesionales con entrenamiento en epidemiolog\u00eda cl\u00ednica, b\u00fasqueda sistem\u00e1tica de la informaci\u00f3n, representantes de la Secretar\u00eda de Salud y la Asociaci\u00f3n Bogotana de Obstetricia y Ginecolog\u00eda. Los participantes presentaron sus conf lictos de inter\u00e9s. A partir de una pregunta cl\u00ednica se realiz\u00f3 la graduaci\u00f3n de los desenlaces y una b\u00fasqueda sistem\u00e1tica que abarc\u00f3 las bases de datos Medline v\u00eda PubMed, Embase, Lilacs, Bireme. La pesquisa se ampli\u00f3 a repositorios institucionales y reportes de vigilancia de resistencia antimicrobiana, sin restricci\u00f3n de idioma o fecha, la b\u00fasqueda se actualiz\u00f3 el 1 de octubre de 2022. Se utiliz\u00f3 la metodolog\u00eda GRADE (Grading of Recommendations Assessment, Development and Evaluation) para valorar la calidad de la evidencia y establecer la fuerza de las recomendaciones.Finalmente, se utiliz\u00f3 la metodolog\u00eda RAND\/ UCLA (Research and Development\/University of California Los Angeles) para el consenso formal. Este documento fue revisado por pares acad\u00e9micos previo a su publicaci\u00f3n.Resultados: el consenso formul\u00f3 las siguientes recomendaciones.Recomendaci\u00f3n 1. Se sugiere que el manejo inicial de la gestante con infecci\u00f3n de v\u00edas urinarias (IVU) altas se realice de forma intrahospitalaria.Recomendaci\u00f3n 2. Como primera opci\u00f3n, se sugiere que el tratamiento antimicrobiano emp\u00edrico de la gestante con IVU altas se realice con el uso de cefalosporinas de segunda generaci\u00f3n con el fin de mejorar la tasa de cura cl\u00ednica y microbiol\u00f3gica.Recomendaci\u00f3n 3. Como segunda opci\u00f3n, se sugiere que el tratamiento antimicrobiano emp\u00edrico de la gestante con IVU altas en el segundo y tercer trimestre se realice con aminogluc\u00f3sidos dado su balance riesgo-beneficio.Recomendaci\u00f3n 4. Como tercera opci\u00f3n, se sugiere que el tratamiento antimicrobiano emp\u00edrico de la gestante con IVU altas se realice con el uso de cefalosporinas de tercera generaci\u00f3n, debido a que el riesgo de inducci\u00f3n de resistencia microbiana es alto con este grupo de antibi\u00f3ticos.Recomendaci\u00f3n 5. Como primera opci\u00f3n, en mujeres gestantes con IVU altas y antecedente de infecci\u00f3n por microorganismos con resistencia a cefalosporinas de tercera o cuarta generaci\u00f3n se sugiere el uso de carbapen\u00e9micos.Recomendaci\u00f3n 6. Como segunda opci\u00f3n, en gestantes con IVU altas y antecedente de infecci\u00f3n por microorganismos con resistencia a cefalosporinas de tercera generaci\u00f3n se sugiere el uso de aminogluc\u00f3sidos o cefalosporinas de cuarta generaci\u00f3n teniendo en cuenta el riesgo-beneficio.Recomendaci\u00f3n 7. Como tercera opci\u00f3n, en gestantes con IVU altas y antecedente de infecci\u00f3n por microorganismos con resistencia a cefalosporinas de tercera o cuarta generaci\u00f3n se sugiere el uso de piperacilina\/tazobactam.Recomendaci\u00f3n 8. En gestantes con IVU altas se recomienda realizar urocultivo previo al inicio de tratamiento antimicrobiano emp\u00edrico.Recomendaci\u00f3n 9. En gestantes con IVU altas, cuando el urocultivo reporte resistencia al antimicrobiano iniciado de forma emp\u00edrica, se sugiere modificar la terapia guiada por los resultados del antibiograma.Recomendaci\u00f3n 10. En la gestante hospitalizada por IVU altas se sugiere realizar el cambio de terapia antimicrobiana a v\u00eda oral cuando la paciente tenga, al menos, 48 horas de modulaci\u00f3n de respuesta inflamatoria sist\u00e9mica y de los signos cl\u00ednicos de infecci\u00f3n, as\u00ed como adecuada tolerancia a v\u00eda oral.Recomendaci\u00f3n 11. En gestantes con IVU altas, sin complicaciones secundarias a la infecci\u00f3n primaria, se recomienda que la terapia antibi\u00f3tica se administre de 7 a 10 d\u00edas.Conclusiones: se espera que este consenso colombiano de IVU altas reduzca la variabilidad en la pr\u00e1ctica cl\u00ednica. Se recomienda a los grupos de investigaci\u00f3n en medicina materno fetal e infectolog\u00eda evaluar la implementaci\u00f3n y efectividad de las recomendaciones emitidas.<\/jats:p>","DOI":"10.18597\/rcog.3984","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T11:42:46Z","timestamp":1681299766000},"page":"37-52","update-policy":"https:\/\/doi.org\/10.18597\/crossmark","source":"Crossref","is-referenced-by-count":5,"title":["Consenso para el tratamiento de la infecci\u00f3n de v\u00edas urinarias altas durante la gestaci\u00f3n","Consensus for the treatment of upper urinary tract infections during pregnancy"],"prefix":"10.18597","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9725-8352","authenticated-orcid":false,"given":"Juan Sebasti\u00e1n","family":"Molina-Mu\u00f1oz","sequence":"first","affiliation":[{"name":"Universidad Nacional de Colombia, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0890-8470","authenticated-orcid":false,"given":"Jimena","family":"Cuadrado-Angulo","sequence":"additional","affiliation":[{"name":"Universidad Nacional de Colombia, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5355-729X","authenticated-orcid":false,"given":"Carlos Fernando","family":"Grillo-Ardila","sequence":"additional","affiliation":[{"name":"Universidad Nacional de Colombia, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8302-5841","authenticated-orcid":false,"given":"Edith","family":"Angel-M\u00fcller","sequence":"additional","affiliation":[{"name":"Universidad Nacional de Colombia, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0882-9652","authenticated-orcid":false,"given":"Jorge Alberto","family":"Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Universidad Nacional de Colombia, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3063-3821","authenticated-orcid":false,"given":"Aura Luc\u00eda","family":"Leal-Castro","sequence":"additional","affiliation":[{"name":"Universidad Nacional de Colombia, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9112-9958","authenticated-orcid":false,"given":"Maria Teresa","family":"Vallejo-Ortega","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Cancerolog\u00eda, Bogot\u00e1 (Colombia)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7913","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"key":"93275","doi-asserted-by":"crossref","unstructured":"Foxman B. 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