<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0034-7434</journal-id>
<journal-title><![CDATA[Revista Colombiana de Obstetricia y Ginecología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Colomb Obstet Ginecol]]></abbrev-journal-title>
<issn>0034-7434</issn>
<publisher>
<publisher-name><![CDATA[Federación Colombiana de Obstetricia y GinecologíaRevista Colombiana de Obstetricia y Ginecología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0034-74342023000100037</article-id>
<article-id pub-id-type="doi">10.18597/rcog.3984</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Consenso para el tratamiento de la infección de vías urinarias altas durante la gestación]]></article-title>
<article-title xml:lang="en"><![CDATA[Consensus for the treatment of upper urinary tract infections during pregnancy]]></article-title>
</title-group>
<aff id="A">
<institution><![CDATA[,  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2023</year>
</pub-date>
<volume>74</volume>
<numero>1</numero>
<fpage>37</fpage>
<lpage>52</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0034-74342023000100037&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0034-74342023000100037&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0034-74342023000100037&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Objetivos: Generar recomendaciones informadas en la evidencia, a través de un consenso formal, orientadas al tratamiento de la infección de vías urinarias altas durante la gestación.  Materiales y métodos: En el grupo desarrollador participaron expertos temáticos en microbiología, salud pública, medicina interna, infectología, obstetricia, medicina materno-fetal e infectología ginecobstétrica. También hicieron parte profesionales con entrenamiento en epidemiología clínica, búsqueda sistemática de la información, representantes de la Secretaría de Salud y la Asociación Bogotana de Obstetricia y Ginecología. Los participantes presentaron sus conflictos de interés. A partir de una pregunta clínica se realizó la graduación de los desenlaces y una búsqueda sistemática que abarcó las bases de datos Medline vía PubMed, Embase, Lilacs, Bireme. La pesquisa se amplió a repositorios institucionales y reportes de vigilancia de resistencia antimicrobiana, sin restricción de idioma o fecha, la búsqueda se actualizó el 1 de octubre de 2022. Se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para valorar la calidad de la evidencia y establecer la fuerza de las recomendaciones. Finalmente, se utilizó la metodología RAND/ UCLA (Research and Development/University of California Los Angeles) para el consenso formal. Este documento fue revisado por pares académicos previo a su publicación.  Resultados: El consenso formuló las siguientes recomendaciones. Recomendación 1. Se sugiere que el manejo inicial de la gestante con infección de vías urinarias (IVU) altas se realice de forma intrahospitalaria. Recomendación 2. Como primera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de segunda generación con el fin de mejorar la tasa de cura clínica y microbiológica. Recomendación 3. Como segunda opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas en el segundo y tercer trimestre se realice con aminoglucósidos dado su balance riesgo-beneficio. Recomendación 4. Como tercera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de tercera generación, debido a que el riesgo de inducción de resistencia microbiana es alto con este grupo de antibióticos. Recomendación 5. Como primera opción, en mujeres gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de carbapenémicos. Recomendación 6. Como segunda opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera generación se sugiere el uso de aminoglucósidos o cefalosporinas de cuarta generación teniendo en cuenta el riesgo-beneficio. Recomendación 7. Como tercera opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de piperacilina/tazobactam. Recomendación 8. En gestantes con IVU altas se recomienda realizar urocultivo previo al inicio de tratamiento antimicrobiano empírico. Recomendación 9. En gestantes con IVU altas, cuando el urocultivo reporte resistencia al antimicrobiano iniciado de forma empírica, se sugiere modificar la terapia guiada por los resultados del antibiograma. Recomendación 10. En la gestante hospitalizada por IVU altas se sugiere realizar el cambio de terapia antimicrobiana a vía oral cuando la paciente tenga, al menos, 48 horas de modulación de respuesta inflamatoria sistémica y de los signos clínicos de infección, así como adecuada tolerancia a vía oral. Recomendación 11. En gestantes con IVU altas, sin complicaciones secundarias a la infección primaria, se recomienda que la terapia antibiótica se administre de 7 a 10 días.  Conclusiones: se espera que este consenso colombiano de IVU altas reduzca la variabilidad en la práctica clínica. Se recomienda a los grupos de investigación en medicina materno fetal e infectología evaluar la implementación y efectividad de las recomendaciones emitidas.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Objectives: To generate evidence-based recommendations through formal consensus regarding the treatment of upper urinary tract infections during gestation.  Materials and methods: Experts in microbiology, public health, internal medicine, infectious diseases, obstetrics, maternal fetal medicine and obstetric and gynecological infections participated in the consensus development group. The group also included professionals with training in clinical epidemiology, systematic data search, and representatives from the Health Secretariat and the Bogota Obstetrics and Gynecology Association. The participants disclosed their conf licts of interest. Starting with a clinical question, outcomes were graded and a systematic search was conducted in the Medline via PubMed, Embase, Lilacs, and Bireme databases. The search was expanded to include institutional repositories and antimicrobial resistance surveillance systems, with no language or date restrictions. The search was updated on October 1, 2022. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to assess the quality of the evidence and determine the strength of the recommendations. Finally, the RAND/UCLA (Research and Development/University of California Los Angeles) methodology was applied for the formal consensus. This document was reviewed by academic peers before publication.  Results: The following are the consensus recommendations. Recommendation 1. The initial management of pregnant women with upper urinary tract infections (UTIs) should be approached in a hospital setting. Recommendation 2. The use of second generation cephalosporins is the suggested first option for empirical antimicrobial management in pregnant women with upper UTI in order to improve the rates of clinical and microbiological cure. Recommendation 3. Because of the risk-benefit balance, the use of aminoglycosides is suggested as a second option for empirical antimicrobial treatment in pregnant women presenting with upper UTIs in the second and third trimester. Recommendation 4. The use of third-generation cephalosporins is suggested as the third option for empirical antimicrobial treatment in pregnant women with upper UTIs given that the risk of inducing microbial resistance is high with this group of antibiotics. Recommendation 5. The use of carbapenems is suggested as a first option in pregnant women with upper UTIs and a history of infections caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 6. The use of aminoglycosides or fourth-generation cephalosporins is suggested as a second option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third-generation cephalosporins, taking risk-benefit into account. Recommendation 7. The use of piperacillin/tazobactam is suggested as a third option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 8. Getting a urine culture is recommended in pregnant women with upper UTIs before initiating empirical antimicrobial treatment. Recommendation 9. In pregnant women with upper UTIs, it is suggested to modify therapy in accordance with the results of the sensitivity test when the culture report shows resistance to the antimicrobial agent initiated empirically. Recommendation 10. In pregnant women hospitalized due to upper UTIs, it is suggested to switch to oral antimicrobial therapy after at least 48 hours of modulation of the systemic inflammatory response and the clinical signs of infection, and when tolerance to oral intake is adequate. Recommendation 11. In pregnant women with upper UTIs with no complications secondary to the primary infection, it is recommended to administer antibiotic therapy for a period of 7 to 10 days.  Conclusions: It is expected that with this Colombian upper UTI consensus variability in clinical practice will be reduced. It is recommended that groups doing research in maternal fetal medicine assess the implementation and effectiveness of these recommendations.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[pielonefritis]]></kwd>
<kwd lng="es"><![CDATA[antibiótico]]></kwd>
<kwd lng="es"><![CDATA[resistencia antimicrobiana]]></kwd>
<kwd lng="es"><![CDATA[infección urinaria]]></kwd>
<kwd lng="en"><![CDATA[Pyelonephritis]]></kwd>
<kwd lng="en"><![CDATA[antibiotic]]></kwd>
<kwd lng="en"><![CDATA[antimicrobial resistance]]></kwd>
<kwd lng="en"><![CDATA[urinary infection]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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