Most Antibiotics Safe to Use During Pregnancy

News Author: Emma Hitt, PhD
CME Author: Laurie Barclay, MD

May 31, 2011 — During the second and third trimester of pregnancy, sulfonamides and nitrofurantoins may be used as first-line agents for urinary tract and other infections, but in the first trimester, these agents may be used when no alternatives are available, according to a Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).

The opinion is published in the June issue of Obstetrics & Gynecology. According to the study authors, a 2009 case-control study of data from the National Birth Defects Prevention Study found that nitrofurans and sulfonamides were significantly associated with multiple birth defects, whereas penicillins, erythromycin, cephalosporins, and the quinolones were not.

However, the authors acknowledge several limitations of the 2009 study. In addition, they note that "other studies have not found such risks among other populations or when using different epidemiologic methods."

According to the authors, antibiotics "should be prescribed for pregnant women only for appropriate indications and for the shortest effective duration."

They add that many urine cultures show bacterial contaminants that do not represent true infection. However, when selecting an antibiotic for a true infection during the first trimester, "health care providers should consider and discuss with patients the benefits as well as the potential unknown risks of teratogenesis and maternal adverse reactions."

They suggest that prescribing sulfonamides or nitrofurantoins in the first trimester is still considered appropriate when no other suitable alternative antibiotics are available.

"During the second and third trimesters, sulfonamides and nitrofurantoins may continue to be used as first-line agents for the treatment and prevention of urinary tract infections and other infections caused by susceptible organisms," they write.

They also caution that "pregnant women should not be denied appropriate treatment for infections because untreated infections can commonly lead to serious maternal and fetal complications."

Obstet Gynecol. 2011;117:1484-1485. Abstract

Related Link 

The National Women’s Health Information Center, a service of the US Department of Health and Human Service’s Office on Women’s Health, provides a comprehensive Web site, useful for patient education, on the subject ofPregnancy and Medicines.

http://www.medscape.org/viewarticle/743614?src=cmemp

regards, taniafdi ^_^

Cell Phones of Hospital Patients Carry Pathogenic Bacteria

Laurie Barclay, MD

June 7, 2011 — Mobile phones (MPs) of hospital patients and their visitors carry a higher risk for nosocomial pathogen colonization than do the MPs of healthcare workers (HCWs), according to the results of a cross-sectional study published in the June issue of theAmerican Journal of Infection Control.

"In contrast to [the] benefits of these devices, some investigators have reported that MPs of medical personnel may be a potential source of bacterial pathogens in the hospital setting," write Mehmet Sait Tekerekoglu, MD, from the Department of Medical Microbiology, Faculty of Medicine, Inonu University in Malatya, Turkey, and colleagues. "However, there are little data about the infection threat offered by the MPs of the persons except HCWs. The present study was conducted to determine whether MPs of patients, patients' companions, and visitors carry any pathogenic bacteria likely to cause infection in hospital wards."

Swab samples were collected from the keypads, microphones, and earpieces of 200 MPs, including 67 MPs belonging to HCWs and 133 belonging to patients, patients' companions, and visitors.

Pathogenic bacteria were cultured from 39.6% of MPs of the patients and visitors compared with 20.6% of MPs of the HCWs (P = .02). Multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus, extended-spectrum b-lactamase-producing Escherichia coli, Klebsiella species, high-level aminoglycoside-resistant Enterococcus species, and carabepenem-resistant Acinetobacter baumanii, were cultured from 7 MPs of patients and visitors compared with none of the MPs of HCWs.

"Our findings suggest that [MPs] of patients, patients' companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs," the study authors write. "Specific infection control measures may be required for this threat."

Limitations of this study include its cross-sectional design and the relatively low number of medical personnel included in the study.

"However, regardless of the number of HCWs inclusions, the types of bacteria that were found on the patients' MPs and their resistance patterns were very worrisome," the study authors conclude. "We thought that low socioeconomic status of the patients and awareness about the hospital hygiene were the most possible reasons for the colonization of [multidrug-resistant] pathogen on their MPs. In addition to medical personnel, infection control professionals must consider patients' MPs as a potential source of infection."

The study authors have disclosed no relevant financial relationships.

Am J Infect Control. 2011;39:379-381. Abstract

regards, taniafdi ^_^