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infection in pregnant patients

Notes: A woman in the 3rd trimester of pregnancy is immunosuppressed. 1) defects in neutrophil chemotaxis 2) defects in delayed-type T-cell mediated immunity Special considerations 1) disseminated infection a) Herpes zoster b) coccidioidomycosis 2) urinary tract infection are particularly common a) bacterial growth in urine is promoted by intermittent 1] glycosuria 2] aminoaciduria b) screen for asymptomatic bacteria monthly c) treat asymptomatic bacteria for 10-14 days d) asymptomatic urinary tract infections progress to pyelonephritis in 40% of pregnant women e) symptomatic urinary tract infections 1] relapse or reinfect frequently 2] treat aggressively with ampicillin or cephalosporin for 6 weeks 3] pyelonephritis occurs in 1-2% of patients f) post-coital cystitis - treat for 7 days, then once after each episode of intercourse - if history of anaphylaxis with penicillin, treat with nitrofurantoin [7] g) adequate to high fluid intake 3) recurrent skin infections should prompt consideration of MRSA [2] - no evidence MRSA skin infection affects neonate 4) Haemophilus influenzae more common in pregnant women & linked to adverse fetal outcomes - relative risk = 13; absolute risk = 0.0005% [4] Antibiotics generally contraindicated during pregnancy 1) amantadine 2) clarithromycin 3) doxycycline 4) flucytosine 5) quinolones a) lomefloxacin b) ofloxacin c) ciprofloxacin 6) tetracycline 7) bismuth subsalicylate (2nd half of pregnancy) Antibiotics to be avoided if alternatives are available 1) azole & triazole antifungal agents 2) chloramphenicol at term 3) metronidazole 4) aminoglycosides 5) antiparasitic agents 6) antimalarial agents 7) trimethoprim-sulfamethoxazole (Bactrim) 8) most antiviral agents Antibiotics generally regarded as safe during pregnancy 1) beta-lactams - cephalosporins - aztreonam for beta-lactam allergy [7] 2) erythromycin (except estolate) 3) azithromycin a) safe in animal studies b) no studies in humans 4) isoniazid 5) amphotericin B 6) mefloquine also see medications during pregnancy

Specific

HIV infection during pregnancy placentitis

General

infection (infectious disease) pregnancy disorder; obstetric disorder; pregnancy complication

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018.
  2. Laibl VR, Sheffield JS, Roberts S, McIntire DD, Trevino S, Wendel GD Jr. Clinical Presentation of Community-Acquired Methicillin- Resistant Staphylococcus aureus in Pregnancy. Obstet Gynecol. 2005 Sep;106(3):461-5. PMID: 16135574
  3. Prescriber's Letter 16(12): 2009 Antibiotic and Antifungal Use During Pregnancy and Breastfeeding Detail-Document#: 251206 (subscription needed) http://www.prescribersletter.com
  4. Collins S et al Risk of Invasive Haemophilus influenzae Infection During Pregnancy and Association With Adverse Fetal Outcomes. JAMA. 2014;311(11):1125-1132 PMID: 24643602 http://jama.jamanetwork.com/article.aspx?articleid=1841966 - Edwards MS Adverse Fetal Outcomes. Expanding the Role of Infection. JAMA. 2014;311(11):1115-1116 PMID: 24643600 http://jama.jamanetwork.com/article.aspx?articleid=1841951
  5. Kourtis AP, Read JS, Jamieson DJ Pregnancy and Infection N Engl J Med 2014; 370:2211-2218. June 5, 2014 PMID: 24897084 http://www.nejm.org/doi/full/10.1056/NEJMra1213566
  6. Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015 Jul;29(5):598-611. Review. PMID: 25997564
  7. NEJM Knowledge+