We included 342 outpatient and 221 inpatient patients among 563 patients in this experiment based on the inclusion criteria, including prescription data such as region, reimbursement method, and expenses. Chengdu (36.59%), Guangzhou (27.72%), and Shanghai (8.70%) are the top three cities. Over a 5-year period, the average age was 29.60 6.59 years, with roughly 60.21% of women aged 25–34 years. Table 1 shows the demographic features of the patients. The main outpatient departments are Obstetrics and Gynecology (25.75%), Emergency (22.56%), and Urology (3.73%), whereas the main inpatient departments are Obstetrics and Gynecology (20.43%), Urology (7.10%), and Infection (4.44%). Figure 1 shows the departments that have three or more patients.

We counted the number of anti-infective medications used by each patient, and 37 of them used two types of antibiotics, including cephalosporins (403, 71.58%), enzyme inhibitors (66, 11.72%), and penicillin (34, 6.04%). The top five antibiotics were cefuroxime (68, 12.08%), ceftriaxone (59, 10.48%), and cefdinib (54, 9.59%), followed by cefoxitin (39, 6.93%) and cefaclor (36, 6.39%), as shown in Table 2. Figure 2 depicts the distribution of all categories, whereas Figure 3 depicts the matching outpatient/inpatient services. During the 5-year period, there was no substantial change in the type and dosage of antibacterial medications. Cephalosporins were the most commonly used antibiotics overall, as illustrated by the trend chart in Figure 4.

When we analyzed the data, we discovered that there were primarily three types of medication based on the mode of administration: intravenous (328, 54.67%), oral (254, 42.33%), and vaginal (18, 3.00%). Please see Figure 5 for further information. According to the summary data, the dosage supplied was essentially reasonable. For a total of 20 patients, the combined usage and dosage were not given. The therapy period consists primarily of 1 day (234, 39.00%), 3 days (65, 10.83%), 5 days (21, 3.50%), and 7 days (24, 4.00%). Please see Figure 6 for further information.

We computed the total cost and cost per capita for patients utilizing various therapeutic medications. In terms of total cost, the top five medications were cephalosporins, carbapenems, enzyme inhibitors, quinolones, nifurtel, and the number of patients receiving comprehensive treatment drugs. The five most expensive medications per capita were cefuroxime, ceftriaxone, cefdinir, cefoxitin, and cefaclor. See Table 3 for details. Analyzing the data, it was found that the proportion of funds used for injection administration was 78.66%, the proportion for oral administration was 20.03%, and the proportion for vaginal administration was 1.32%.

In the past 5 years, the majority of patients were between the ages of 25 and 34, with an average age of 29.60 6.60 years, according to statistical data. The age of treatment did not increase significantly, and there was no statistically significant change in age (p > 0.01). 50%–60% of pregnancies are diagnosed with a urinary tract infection, making it one of the most prevalent infections during pregnancy (Baraka et al., 2021). It can be separated into lower urinary tract infections, such as asymptomatic bacteriuria (ASB) or acute cystitis (AC), and upper urinary tract infections, such as acute pyelonephritis (APN) (Glaser and Schaeffer, 2015). Estimates place the incidence of ASB in expectant women between 2% and 10% (Bonkat et al., 2018). The exported data on pregnancy combined with UTI is relatively small compared to literature reports, which may be attributable to different diagnostic writing habits in different hospitals or to the large number of ASB patients who did not seek medical attention in a timely manner; simultaneously, there are significant differences in the proportion of patients in different regions due to a variety of factors. This may be the result of various diagnostic criteria, inconsistent calculation criteria, or regional variations in prevalence rates. This study will not draw any premature conclusions.

The age of patients seeking medical treatment has not risen in the last 5 years, showing that patients’ fertility demands are primarily centered around the age of 30. To some extent, the adjustment of childbearing time conventions indicates that as society develops, the number of people suffering from environmental pollution, increased work pressure, and delayed marriage and childbirth does not gradually increase, and people’s ideological concepts are constantly improving and updating (Hu et al., 2004; Liang et al., 2021). Many women believe that age is a significant component in their childbirth decision-making and that they should complete the duty of delivering at a specific age. If they stray from this age convention and have difficulties giving birth, this becomes a major issue. The rising opportunity cost of women’s fertility has made it difficult for them to achieve their fertility goals.

According to data on antibiotic use by patients in major cities around the country, we discovered that outpatient and inpatient patients have the greatest variety and proportion of cephalosporins. When selecting antibiotics during pregnancy, consider the mother’s and fetus’s safety. According to the US Food and Drug Administration (FDA), the majority of the antibacterial medications indicated in International Guidelines are Class B, which indicates no adverse responses have been observed in well-controlled human pregnancy trials. There are limited guidelines that specify treatment for ASB and cystitis (Bonkat et al., 2018; Kranz et al., 2017; Betschart et al., 2020; de Cueto et al., 2017; Caron et al., 2018; Institute of Obstetricians and Gynaecologists, 2018; NICE NG109, 2022; NICE NG111, 2022). This could be due to shifting patterns of worldwide antimicrobial resistance, which means that therapy should be based on urine culture and sensitivity recommendations in laboratory reports, while also taking into account the authorized use of antibiotics during pregnancy.

The guidelines propose using furantoin, fosfomycin, and amoxicillin as the first line of treatment, followed by cephalosporin and amoxicillin (NICE NG109, 2022; Martinez et al., 2014). Distinct countries have distinct antibiotic preferences. A study of doctors in Denmark, Finland, Norway, and Sweden found that β-Lactam antibiotics (particularly pimecillin) and nitrofurantoin are their first-line treatments. In the United States, amoxicillin is commonly used, although trimethoprim and furantoin are favoured in Canada. Penicillin and cephalosporins are recommended in the United Kingdom (Christensen, 2000). This study’s statistical material differs from earlier research in some ways. According to our findings, cephalosporins, penicillin, and enzyme inhibitors continue to have a significant advantage in the anti-infection therapy of pregnant women with UTI in China. This could be because cephalosporins have good safety data (China Medical Women’s Association, 2017), However, drugs such as furantoin, fosfomycin, and others with higher recommended usage levels in other countries are relatively lower in China (Gupta et al., 2011). Doctors may prescribe enzyme inhibitors to individuals who are suffering from severe symptoms.

The selection of medications for the treatment of UTIs during pregnancy must take the safety of the mother and fetus into account (Bookstaver PB et al., 2015). The majority of antibiotics can cross the placenta, and it is crucial to determine whether they will have negative effects on the fetus. However, there is limited research on the effects of medications on the fetus during pregnancy. The majority of information on drug safety comes from animal studies and observational studies. The FDA’s classification of pregnancy lacks high-quality data. Despite the dearth of evidence, numerous antibacterial drugs, such as penicillin, cephalosporin, clindamycin, etc., have been used for several years during pregnancy without adverse maternal or fetal effects. Meta-analysis did not prove which antibacterial drug is best for ASB and symptomatic UTIs; therefore, empirical treatment is determined based on antibacterial spectrum, antibacterial activity, and pathogen culture results, as well as the cost (Gupta et al., 2011; Widmer et al., 2015). Few drugs have been definitively demonstrated safe. Therefore, care should be taken to minimize the number of drugs used, only when the benefits outweigh the risks, selecting drugs with the best safety profile, and employing the lowest effective dose and shortest treatment course.

Penicillin has been widely used and its safety has been confirmed in many studies (China Medical Women’s Association, 2017), including penicillin G, ampicillin, and amoxicillin. Although bacterial resistance is common, it is still the most frontline treatment drug. Cephalosporins are also a class of antibiotics with high safety, and third-generation cephalosporins are commonly used in empirical treatment. Furantoin is very effective in treating lower UTI, and its safety is controversial. The US neonatal defect prevention study suggests that furantoin is associated with congenital malformations such as eye deformities, atrial septal defects, and cleft lip and palate. Looking at it correctly, only 35% of patients can recall the name of the medication used. ACOG believes that it should be used reasonably in the early stages of pregnancy, and can be used as a first-line treatment plan in the middle and late stages of pregnancy. Between 1999 and 2009, a total of 105,492 pregnant women were included, and a total of 6,561 fetuses and newborns were diagnosed with congenital malformations. The incidence of malformations was 5.7% (76 of 1,329) in the exposed group and 6.2% (6,485 of 104,163) in the unexposed group, with no statistically significant differences. Exposure to furantoin in early pregnancy did not increase the incidence of fetal malformations (Goldberg et al., 2013). Phosphomycin is a broad-spectrum antibacterial drug that plays an increasingly significant role in lower urinary tract infections. Trimethoprim sulfamethoxazole is not recommended as a first-line solution. The US neonatal defect prevention study suggests that SMZ is more teratogenic than other drugs, but other studies do not recognize it. ACOG believes that if there are no other drugs available in early pregnancy, this product can be chosen. In addition to teratogenesis, hyperbilirubinemia and nuclear jaundice may occur in late pregnancy.

A systematic evaluation in the Cochrane Database analyzed the most effective treatment methods for symptomatic UTI (cystitis and pyelonephritis) during pregnancy by analyzing the cure rate, recurrence rate, incidence of premature birth, and necessity for antibiotic replacement. The results showed that all the antibiotics studied were effective and had few complications. There is not enough evidence to recommend a specific treatment plan. This study shows that China places more emphasis on effectiveness and safety in the treatment process, with less use of drugs such as furantoin and fosfomycin. Further consideration may be needed on issues such as bacterial resistance (Keating, 2013).

In this study, cephalosporins and penicillin are first-line medications for the treatment of UTI during pregnancy in both outpatient and inpatient patients. A total of 20 patients’ usage and dosage were not specified. Physiological changes in the mother can affect pharmacokinetics and decrease serum drug concentration, increase intravascular and extravascular fluid volume, increase renal blood flow velocity, GFR, and increase fetal drug distribution. In our study, however, we discovered that the dosage provided to pregnant patients stayed at adult levels with no significant modifications. More research is needed to understand whether the dosage of UTI should be increased during pregnancy or adjusted dependent on body weight.

There appears to be no difference in treatment outcomes between 3-day short courses and 7-day long courses, and short courses can reduce costs and side effects, have higher compliance, and reduce fetal drug exposure (Gupta et al., 2011). In our study, the majority of patients were treated for a single day. This may be because the majority of patients had ASB or lower UTI, which did not progress to upper UTI. It may also be due to patients’ concerns regarding the influence of excessive antibiotic use on pregnancy outcomes.

Cephalosporins, carbapenems and enzyme inhibitors account for the highest amount of money used by patients with anti infective drugs. Teicoplanin, tigecycline and carbapenems rank first in terms of per capita cost. New anti infective drugs account for the highest per capita cost. The drugs with the top sales amount are commonly used drugs, including cephalosporin antibiotics. With the promotion of national volume procurement, many cephalosporin antibiotics have been included in the volume variety, which is relatively cheap compared to other types of drugs, but the frequency of use is also high. The per capita medication amount is significantly out of sync with DDDs, because these types of drugs are new types of antibiotics and special grade antibiotics, with relatively high prices. There is a certain trend in drug use in research data from different years. The changes in amount in different years and drug consumption structure show consistency in drug use in hospitals in different regions. It can be seen that everyone has a general consensus on the choice of main treatment drugs. The statistical results show that patients who receive intravenous medication have the highest proportion of medication costs, as compared to those who take oral medication, patients who use intravenous medication have a more severe condition, a larger dosage, and a longer course of treatment, all of which can lead to an increase in drug costs.