Thursday, February 11, 2016

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

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