UTI in Pregnancy

• Asymptomatic bacteriuria occurs in 2 % to 10 % of all pregnancies. If untreated, up to 30 % of mothers may develop acute cystitis and up to 50 % acute pyelonephritis
• E Coli is the most common pathogen associated with asymptomatic bacteriuria (> 80 % of isolates). 
• Asymptomatic bacteriuria has been associated with low birthweight and preterm birth3
• Obstruction to the flow of urine in pregnancy leads to stasis and increases the likelihood that pyelonephritis will complicate asymptomatic bacteriuria
• Antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy
• There is no clear consensus in the literature on antibiotic choice or duration of treatment for urinary tract infection

Treatment

• Intravenous antibiotic treatment should be guided by urine culture and sensitivity reports
• A 7 day course is normally sufficient, however, shortest possible treatment is associated with better fetal outcomes
• Increase fluid intake (may require intravenous fluids if clinically dehydrated)
• Monitor urine output to assess complete emptying of the bladder (assists antimicrobial treatment)
• Urinary alkalisers are safe in pregnancy, however they should not be used in combination with nitrofurantoin as it can result in a loss of treatment efficacy

 Antibiotic

References:

1. South Australian Perinatal Practice Guidelines : urinary tract infections in pregnancy
2. http://www.bpac.org.nz/BPJ/2011/april/pregnant-uti.aspx 
3. http://www.antibioticprescribing.ie/urinary/uti-in-pregnancy
4. http://www.aafp.org/afp/2000/0201/p713.html