405 Acceptance of HIV Testing with an On-Site Prenatal Clinic Counselor
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Volume 166 :-.lumber I, Part 2 404 SUSCEPI' ABIUIY PATI'ERNS OF RECENf PYEWNEPHRITIS PREGANANCY ASSOCIATED PYEWNERITIS BACI'ERlAL ISOLATES. Mark G. Manens M.D.-, Rajender Syal, M.D.-, G. D. Anderson, M.D. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77550-2778 The incidence of pyelonephritis is increased in pregnancy and is directly.',lated to the incidence of bacteriuria by pathogenic organisms. Treatment for pyelonephritis in pregnancy bas cbanged over the years secondary to an alteration in the susceptibility patterns of the respon· sible uropathogen. Ampicillin bas generally been replaced by fIrst gen- eration cephalosporins, such as cefazolin, due to the increased rate of ampicillin resinant Enterobacteriaceae, including E. coli. The current investigation identified the species and sensitivity pattern of recent pyelonephritis in pregnancy isolates. 129 patients and their microbio- logic results were reviewed from 1988-91 with 136 organism recovered including E. coli (62%), Klebsiella pneumoniae (8%), Enterococcus (5%), Proteus mirabilis (4%), and Group B streptococci (3%). Susceptibility patterns to ampicillin, fIrst generation cephalosporins (cefazolin), and advanced generation cephalosporins (cefotaxime) demonstrated a continued increase in resistance to beta-lactamase sensitive antibiotics. % Resistance n= AmpicilUn Cefazole Cefotaxime E. coli 85 35 (41 %) 6 (7%) 0 K. pneumonia II 11 (100%) 1(9%) 0 Enterococcus 7 0 7 (100%) 7 (100%) Enterobacter 2 2 (100%) 2 (100%) 0 Total 105 48 (47%) 16 (15%) 7 (7%) The organisms were significantly more resistant to ampicillin and cefazolin as compared to cefotaxime (p <.001, and p <.01 respectively). Clinically efficacy correlated with bacteriologic results. Therefore, it appears the resistance patterns affecting the effectiveness of ampicillin in the treatment of pyelonephritis in pregnancy have spread to the fIrst generation cephalosporins, perhaps re<juiring the consideration of advanced generation cephalosporins such as cefotaxime as the initial empiric antibiotic of choice. 405 ACCEPTANCE OF HIV TESTING WITH AN ON-SITE PRENATAL CLINIC COUNSELOR_ Neil S.Silverrnan. M.D., Susan M. Weiner, R.N.C .. M.S.N.X, Donna B.A.', Depts. of Ob/Gyn and Pediatrics, Jefferson Medical College, Philadelphia, PA Background· Heterosexual transmission and drug-related acquisition of human immunodefIciency virus (mY) have been recognized as major contributors to the rising rate of HlV infection in women of reproductive age. Pregnancy in these women is complicated by the potential for maternal-fetal transmission of the virus. This factor has created social and ethical dilemmas regarding HIV testing in this population, since it may not include appropriate explanation of the implications of HIY infection prior to testing. Obiectlve: This study evaluated patient acceptance of confIdential HIV testing in an hUler-city prenatal clinic after the placement of an on-site HlV counselor. All patients registering for prenatal care received HIY counseling, after which they were offered confidential HIV testing. Those patients who consented to testing received a time for post-test counseling and release of results. The number of patients tested was compared to the number of my tests ordered in the prior six months via physician-consented, risk-directed testing at prenatal intake. RnlI.l15.i. Pre-counselor With Counselor Pts counselled 814 839 Pts tested (% of counselled) 83 (10.2%) 549 (65%) Positive results (% of tested) 0 3 (0.4%) Post-test counselled (% of tested) N/A 281 (34%) Conclusions: ConfIdential HIY testing was well accepted in an inner-city pregnant population in conjunction with a full-time, on- site HIY counselor, with six times as many patients consenting to testing than before the current system was in place. This may result from both improved quality of education as well as separation of my testing as a medical directive. spa Abstracts 387 406 HEPATITIS C VIRUS (HCY) IN PREGNANCY: SEROPREVALENCE AND RISK FACTORS FOR INFECTION. Neil S. Silverman, M.D., 407 Brenda Jenkin, M.D.x, Christine Wu, M.D.X, Patricia McGillen, M.T. (ASCP)x, Gerald Knee, M.S. X, Jefferson Medical College, Phil a., PA Background; Though limited reports do exist describing the prevalence of specific anti-HCY antibodies in post-transfusion and other at-risk populations, none exist in prenatal populations. In order to address the vertical transmissibility of HCV, the prevalence of seropositivity in the population in question must first be determined. The of this study Were to: I) anonymously compare the seroprevalence of anti-Hey in an inner-city prenatal clinic to that of a group of private patients; 2) to assess the use of risk factors to prcdict an increased rate of anti-HCY seropositivity; 3) to identify co- infection risks for HCY and other blood-borne agents. M..e.l.b.!!ll.s Blood samples were collected at the time of routine prenatal screening. They were then anonymously analyzed for HCV, HIV, HTLV-l and RPR using commercially available assays. Overall (n-599) Clinic (n-444) Private (n-155) HCV+ 26 (4.3%) 23 (5.2%) 3 (1.5%) HTLY-I+ 5 (0.8%) 4 (0.9%) 1 (0.6%) HIY+ 3 (0.5%) 3 (0.7%) 0 (0%) HBsAg+ 5 (0.8%) 4 (0.9%) 1 (0.6%) RPR+ 16 (2.7%) 14 (3.2%) 2 (1.3%) Seropositivity for anti-Hey was significantly higher overall and in the clinic than for either HTLY-I or HIV (p<O.OOOI), a statistic which did not hold for the private patients tested. In the clinic, only 52% of HCV-positive patients would havc been predictcd via targcting by risk factors; only I of 3 positive patients in the private offices would have been so identified. Conclusions; Hev infection may be of greater concern than previously thought in inner-city pregnant populations and, as with hepatitis B, not well-predicted by risk-factor identification. Further study is warranted to detcffiline matcmal- fetal transmissibility. PENTAMIDINE PROPHYLAXIS IN PREGIIANCY _ D.Nanda X , I Tamenbaua", S landesEn X , H Ilendez X , G Moroso X , H Minkoff_ SUllY/Health science Center, Brooklyn NY. Pneunocystitis carini pneunonia (PCP) is one of the coomonest opportunistic Infections (01) among patients with AIDS. Prophylactic agents such as Aerosolized Pentamidine have substantially reduced the incidence of PCP among susceptible patients. At SUNY/HSCB and IeCHe, a study was undertaken to assess the effects of Pentamidine use during pregnancy. METHOD: Fifteen HIV infected patients with T4 counts <200/cnm or <20% of total lywphocytes were given PCP prophylaxis during pregnancy_ Detai led history including that of STDs, drug use and other concomitant medications was taken & complete examination and full laboratory assessment was done on each patient. The patients were then administered 300 mg of Pentamidine via a respiragard nebulizer monthly, during II & III trimesters. Serum Pentamidine levels were drawn within an hour of inhalation & were frozen for HPLC assay. The patients were followed prospectively at prenatal cl inics and del ivered at the two study institutions. RESULTS: Fifteen mothers received a total of 35 doses of pentamidine for an average of 2.3 doses per patient (range One patient with a history of asthma received 60 mg bimonthly. Five patients received AZT concurrently. None of the patients reported any adverse effects of therapy or breakthrough PCP. Serum levels ranged from undetectable to 7ng/ml (reports among non pregnant patients have ranged from 0 to 30.91 ng/ml) . One patient discontinued prophylaxis and developed PCP about 70 days after the last dose. All patients delivered at term; All but one delivered vaginally. Mean birth weight was 3159_07!: 380 gms (range 2500 - 3570) and head circumference was 33_9+1.1 (range 31-35"",)_ Average one and 5 minute apgar scores were7.9.:t 1.3 and 8.7,:t 1.1 respectively_ None of the babies developed any inmediate problems in the neonatal period. CONCLUSICIIS: 1. Aerosol ized pentamidine during pregnancy did not achieve high blood levels during pregnancy. 2. No breakthrough PCP was observed in any patient receiving prophylaxis. 3.Pregnant patients tolerated the drug well without any major side effects_ 4. No significant effects on the course of pregnancy were observed. 5. larger studies are needed to fully determine the efficacy and safety of pentamidine during pregnancy.
Transcript of 405 Acceptance of HIV Testing with an On-Site Prenatal Clinic Counselor
Volume 166 :-.lumber I, Part 2
404 SUSCEPI' ABIUIY PATI'ERNS OF RECENf PYEWNEPHRITIS PREGANANCY ASSOCIATED PYEWNERITIS BACI'ERlAL ISOLATES. Mark G. Manens M.D.-, Rajender Syal, M.D.-, G. D. Anderson, M.D. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77550-2778
The incidence of pyelonephritis is increased in pregnancy and is directly.',lated to the incidence of bacteriuria by pathogenic organisms. Treatment for pyelonephritis in pregnancy bas cbanged over the years secondary to an alteration in the susceptibility patterns of the respon· sible uropathogen. Ampicillin bas generally been replaced by fIrst generation cephalosporins, such as cefazolin, due to the increased rate of ampicillin resinant Enterobacteriaceae, including E. coli. The current investigation identified the species and sensitivity pattern of recent pyelonephritis in pregnancy isolates. 129 patients and their microbiologic results were reviewed from 1988-91 with 136 organism recovered including E. coli (62%), Klebsiella pneumoniae (8%), Enterococcus (5%), Proteus mirabilis (4%), and Group B streptococci (3%). Susceptibility patterns to ampicillin, fIrst generation cephalosporins (cefazolin), and advanced generation cephalosporins (cefotaxime) demonstrated a continued increase in resistance to beta-lactamase sensitive antibiotics.
% Resistance ~ n= AmpicilUn Cefazole Cefotaxime E. coli 85 35 (41 %) 6 (7%) 0 K. pneumonia II 11 (100%) 1(9%) 0 Enterococcus 7 0 7 (100%) 7 (100%) Enterobacter 2 2 (100%) 2 (100%) 0 Total 105 48 (47%) 16 (15%) 7 (7%) The organisms were significantly more resistant to ampicillin and cefazolin as compared to cefotaxime (p <.001, and p <.01 respectively). Clinically efficacy correlated with bacteriologic results. Therefore, it appears the resistance patterns affecting the effectiveness of ampicillin in the treatment of pyelonephritis in pregnancy have spread to the fIrst generation cephalosporins, perhaps re<juiring the consideration of advanced generation cephalosporins such as cefotaxime as the initial empiric antibiotic of choice.
405 ACCEPTANCE OF HIV TESTING WITH AN ON-SITE PRENATAL CLINIC COUNSELOR_ Neil S.Silverrnan. M.D.,
Susan M. Weiner, R.N.C .. M.S.N.X, Donna Weis~ B.A.', Depts. of Ob/Gyn and Pediatrics, Jefferson Medical College, Philadelphia, PA
Background· Heterosexual transmission and drug-related acquisition of human immunodefIciency virus (mY) have been recognized as major contributors to the rising rate of HlV infection in women of reproductive age. Pregnancy in these women is complicated by the potential for maternal-fetal transmission of the virus. This factor has created social and ethical dilemmas regarding HIV testing in this population, since it may not include appropriate explanation of the implications of HIY infection prior to testing. Obiectlve: This study evaluated patient acceptance of confIdential HIV testing in an hUler-city prenatal clinic after the placement of an on-site HlV counselor. ~ All patients registering for prenatal care received HIY counseling, after which they were offered confidential HIV testing. Those patients who consented to testing received a time for post-test counseling and release of results. The number of patients tested was compared to the number of my tests ordered in the prior six months via physician-consented, risk-directed testing at prenatal intake. RnlI.l15.i.
Pre-counselor With Counselor Pts counselled 814 839 Pts tested (% of counselled) 83 (10.2%) 549 (65%) Positive results (% of tested) 0 3 (0.4%) Post-test counselled (% of tested) N/A 281 (34%) Conclusions: ConfIdential HIY testing was well accepted in an inner-city pregnant population in conjunction with a full-time, onsite HIY counselor, with six times as many patients consenting to testing than before the current system was in place. This may result from both improved quality of education as well as separation of my testing as a medical directive.
spa Abstracts 387
406 HEPATITIS C VIRUS (HCY) IN PREGNANCY: SEROPREVALENCE AND RISK FACTORS FOR INFECTION. Neil S. Silverman, M.D.,
407
Brenda Jenkin, M.D.x, Christine Wu, M.D.X, Patricia McGillen, M.T. (ASCP)x, Gerald Knee, M.S. X, Jefferson Medical College, Phil a., PA
Background; Though limited reports do exist describing the prevalence of specific anti-HCY antibodies in post-transfusion and other at-risk populations, none exist in prenatal populations. In order to address the vertical transmissibility of HCV, the prevalence of seropositivity in the population in question must first be determined. The ~ of this study Were to: I) anonymously compare the seroprevalence of anti-Hey in an inner-city prenatal clinic to that of a group of private patients; 2) to assess the use of risk factors to prcdict an increased rate of anti-HCY seropositivity; 3) to identify coinfection risks for HCY and other blood-borne agents. M..e.l.b.!!ll.s Blood samples were collected at the time of routine prenatal screening. They were then anonymously analyzed for HCV, HIV, HTLV-l and RPR using commercially available assays. ~
Overall (n-599) Clinic (n-444) Private (n-155) HCV+ 26 (4.3%) 23 (5.2%) 3 (1.5%) HTLY-I+ 5 (0.8%) 4 (0.9%) 1 (0.6%) HIY+ 3 (0.5%) 3 (0.7%) 0 (0%) HBsAg+ 5 (0.8%) 4 (0.9%) 1 (0.6%) RPR+ 16 (2.7%) 14 (3.2%) 2 (1.3%) Seropositivity for anti-Hey was significantly higher overall and in the clinic than for either HTLY-I or HIV (p<O.OOOI), a statistic which did not hold for the private patients tested. In the clinic, only 52% of HCV-positive patients would havc been predictcd via targcting by risk factors; only I of 3 positive patients in the private offices would have been so identified. Conclusions; Hev infection may be of greater concern than previously thought in inner-city pregnant populations and, as with hepatitis B, not well-predicted by risk-factor identification. Further study is warranted to detcffiline matcmal- fetal transmissibility.
PENTAMIDINE PROPHYLAXIS IN PREGIIANCY _ D.NandaX, I Tamenbaua", S landesEnX, H IlendezX, G MorosoX, H Minkoff_ SUllY/Health science Center, Brooklyn NY. Pneunocystitis carini pneunonia (PCP) is one of the coomonest opportunistic Infections (01) among patients with AIDS. Prophylactic agents such as Aerosolized Pentamidine have substantially reduced the incidence of PCP among susceptible patients. At SUNY/HSCB and IeCHe, a study was undertaken to assess the effects of Pentamidine use during pregnancy. METHOD: Fifteen HIV infected patients with T4 counts <200/cnm or <20% of total lywphocytes were given PCP prophylaxis during pregnancy_ Detai led history including that of STDs, drug use and other concomitant medications was taken & complete examination and full laboratory assessment was done on each patient. The patients were then administered 300 mg of Pentamidine via a respiragard nebulizer monthly, during II & III trimesters. Serum Pentamidine levels were drawn within an hour of inhalation & were frozen for HPLC assay. The patients were followed prospectively at prenatal cl inics and del ivered at the two study institutions. RESULTS: Fifteen mothers received a total of 35 doses of pentamidine for an average of 2.3 doses per patient (range 1~5). One patient with a history of asthma received 60 mg bimonthly. Five patients received AZT concurrently. None of the patients reported any adverse effects of therapy or breakthrough PCP. Serum levels ranged from undetectable to 4~ 7ng/ml (reports among non pregnant patients have ranged from 0 to 30.91 ng/ml) . One patient discontinued prophylaxis and developed PCP about 70 days after the last dose. All patients delivered at term; All but one delivered vaginally. Mean birth weight was 3159_07!: 380 gms (range 2500 -3570) and head circumference was 33_9+1.1 (range 31-35"",)_ Average one and 5 minute apgar scores were7.9.:t 1.3 and 8.7,:t 1.1 respectively_ None of the babies developed any inmediate problems in the neonatal period. CONCLUSICIIS: 1. Aerosol ized pentamidine during pregnancy did not achieve high blood levels during pregnancy. 2. No breakthrough PCP was observed in any patient receiving prophylaxis. 3.Pregnant patients tolerated the drug well without any major side effects_ 4. No significant effects on the course of pregnancy were observed. 5. larger studies are needed to fully determine the efficacy and safety of pentamidine during pregnancy.
