Poster Session 4
Daniel J. Martingano, DO, MBA, PhD
Clerkship Director, IRB Chair, Associate Program Director / Division Chair
St. John's Episcopal Hospital-South Shore and William Carey University College of Osteopathic Medicine
Far Rockaway, New York, United States
Amanda F. Francis Oladipo, MD, MSCR (she/her/hers)
Director of Research
Hackensack University Medical Center
Hackensack, New Jersey, United States
Marwah Al-Dulaimi, MD (she/her/hers)
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Sandra Kumwong, MS
Medical Student
Touro College of Osteopathic Medicine-Harlem Campus
New York, New York, United States
Andrea Ouyang, MSc
Medical Student
William Carey University
Hattiesburg, Mississippi, United States
Lauren Cue, MD, BA (she/her/hers)
OB/GYN Resident
Rutgers University and the Jersey City Medical Center
Jersey City, New Jersey, United States
Ashley Nguyen, MD
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Francis X. Martingano, MD
Assistant Professor, Senior Minimally Invasive Surgeon
NYU Grossman School of Medicine - NYU Brooklyn
New York, New York, United States
Shailini Singh, MD
Director of Metabolic Syndrome
AtlantiCare Regional Medical Center
Pamona, New Jersey, United States
Alexander Ulfers, DO
Medical Director, Maternal Infant Care Center; Maj, USAF, MC
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Mark Rebolos, MD
Director of Patient Safety, Labor & Delivery
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Kristin Cohen, CNM, DNP
Women's Health Care Practitioner
RWJBarnabas Health - Trinitas Regional Medical Center
Elizabeth, New Jersey, United States
Donald Morrish, MD
Chief Executive Officer
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Iffath A. Hoskins, MD
Former ACOG President, Director of Labor & Delivery, Chief Safety Officer
Albert Einstein College of Medicine - Montefiore Medical Center
New York, New York, United States
We conducted a multi-center, prospective observational study from 7/2022 to 7/2024 and included all pregnant women diagnosed with acute pyelonephritis in the 2nd trimester receiving initial antibiotic treatment with either piperacillin-tazobactam or ceftriaxone. Choice of regimen was determined by physician preference. Pyelonephritis diagnostic criteria included presence of fever of 38.0°C, costovertebral angle tenderness, and urinalysis suggestive of urinary tract infection. Primary outcomes included inpatient length of stay (LOS), adult respiratory distress syndrome (ARDS), urosepsis, intensive care unit (ICU) admission and preterm labor. Patients were excluded if they received additional antibiotics before admission, had preexisting renal disease, or had an allergy to either medication.
Results:
The study included 404 patients, with 235 receiving piperacillin-tazobactam and 169 receiving ceftriaxone. Baseline demographic factors were not significantly different. The causative uropathogen was not significantly different between treatment groups. Patients receiving piperacillin-tazobactam had lower rates of ICU admissions (5.1% v. 10.7% p=0.003) and a shorter LOS (2.6 v. 3.1 days, p=0.041) with a 44% (RR=0.56, 95% CI 0.31-0.71, p=0.004) and 17% (RR=0.83, 95% CI 0.79-0.95, p=0.001) decreased risk in confounder adjusted models, respectively. Patients receiving ceftriaxone had higher rates of ARDS (2.96% v. 0.85%, p< 0.001) with an 18% increased risk in adjusted models (RR=1.18, 95%CI 1.10-1.32, p=0.005).
Conclusion:
Piperacillin-tazobactam is a reasonable choice for initial antibiotic treatment for 2nd trimester pregnancies complicated by acute pyelonephritis.
