Vinson R. 26. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Hobbins JC, This project aimed to look into strategies for improving the management of UTI in elderly medical inpatients. 1995;86:119–23. … A randomized study of 90 obstetric inpatients with pyelonephritis compared treatment with oral cephalexin to treatment with intravenous cephalothin (Keflin) and found no difference between the two groups in the success of therapy, infant birth weight or preterm deliveries.27. 1986;31:23–6. Nursing Interventions. 20. Resistance of urinary tract isolates of Escherichia coli to cotrimoxazole, sulphonamide, trimethoprim and ampicillin: an 11-year survey. Washington, D.C.: American College of Obstetricians and Gynecologists, March 1998;245:8–10. Campbell-Brown M, Copyright © 2020 American Academy of Family Physicians. 2c. Effective prophylaxis for recurrent urinary tract infections during pregnancy. Learn more from WebMD about the causes, symptoms, treatment, and prevention of UTIs in pregnancy. Definition Normal urine is sterile:therefore infection could, 1985;92:506–10. Mazor M, Krieger JN. Naessens JM, Fosfomycin (Monurol) is a new antibiotic that is taken as a single dose. 5. The indication to perform an intravenous pyelogram is persistent infection after appropriate antibiotic therapy when there is the suggestion of a structural abnormality not evident on ultrasonography.30 Even the low-dose radiation involved in an intravenous pyelogram, however, may be dangerous to the fetus and should be avoided if possible. Br J Obstet Gynaecol. Historically, ampicillin has been the drug of choice, but in recent years E. coli has become increasingly resistant to ampicillin.19 Ampicillin resistance is found in 20 to 30 percent of E. coli cultured from urine in the out-patient setting.20 Nitrofurantoin (Macrodantin) is a good choice because of its high urinary concentration. Leigh DA, What are the presenting features, signs and symptoms of UTI? Leveno KJ, Infect Dis Clin North Am. Baltimore: Williams & Wilkins, 1996. 34. Bacteriuria in pregnancy treated with a single dose of cephalexin. 1979;53:71–3. Millar LK. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. Single-dose antimicrobial therapy for asymptomatic bacteriuria during pregnancy. The rightsholder did not grant rights to reproduce this item in electronic media. 8600 Rockville Pike Postgrad Med. Cunningham FG, Bacteriuria in pregnancy. A study of various tests to detect asymptomatic urinary tract infections in an obstetric population. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. 1994;169:1390–2. Escherichia coli accounts for 80 to 90 percent of infections. Hobbins JC, Patterson TF, Increased knowledge of preventive measures and treatment modalities. Plante DA. •Diagnosis of UTI should be based on a combination of: • clinical diagnosis based on typical symptoms • microbiological diagnosis by appropriate use of urine dipsticks and urine culture where indicated • past response to antibiotic treatment of isolated episodes of acute UTI Anaerobic and other fastidious microorganisms in asymptomatic bacteriuria in pregnant women. Cararach V. The increased number of false negatives and the relatively poor predictive value of a positive test make the faster methods less useful; therefore, a urine culture should be routinely obtained in pregnant women to screen for bacteriuria at the first prenatal visit and during the third trimester.10,11. Wing DA, Masterton RG, Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. 9. Relationship of bacteriuria in pregnancy to acute pyelonephritis, prematurity, and fetal mortality. Torres PJ, 39. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. All rights Reserved. Please enable it to take advantage of the complete set of features! Millar LK, Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy. Brumfitt W. Guide to clinical preventive services: report of the U.S. Preventive Services Task Force. Prevention of perinatal group B streptococccal disease: a public health perspective. Duff P. Thomsen AC, Clin Infect Dis 1992;14:810–4. Immediate, unlimited access to all AFP content. Urinary Tract Infections During Pregnancy. In the pregnant patient, this higher rate of recurrence with shorter treatment periods may have serious consequences. Information from Duff P. Antibiotic selection for infections in obstetric patients. Sulfonamides can be taken during the first and second trimesters but, during the third trimester, the use of sulfonamides carries a risk that the infant will develop kernicterus, especially preterm infants. Neonatal outcomes that are associated with UTI include sepsis and pneumonia (specifically, group B streptococcus infection).31,42 UTI increases the risk of low-birth-weight infants (weight less than 2,500 g [5 lb, 8 oz]), prematurity (less than 37 weeks of gestation at delivery) and preterm, low-birth-weight infants (weight less than 2,500 g and less than 37 weeks of gestation at delivery)39  (Table 337). Thomsen AC, Copyright © 2000 by the American Academy of Family Physicians. Semin Perinatol 1993;17:367–78, and Krieger JN. Clin Infect Dis. Guidance is in agreement that pregnant women with UTI be offered an immediate antibiotic to prevent complications such as pyelonephritis. Handler A, Fairley KF, Results from the HALT Study. Fairley KF, This article explores the pathophysiology of UTIs and diagnosis, prevention and nursing management in a variety of care settings. Gilstrap LC 3d, Members of various medical faculties develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family and Community Medicine at the University of Missouri–Columbia School of Medicine, Columbia, Mo. 1. 42. Urinary infection in pregnancy. However, hospitalization is indicated for patients who are exhibiting signs of sepsis, who are vomiting and unable to stay hydrated, and who are having contractions. 2015 Jul 26. Evans DC, Gilbert GL. Am Fam Physician. Lower urinary tract dysfunction in pregnancy: a review. This is a corrected version of the article that appeared in print. 1995;50:675–83. 2b. Compton A, Management of acute uncomplicated infections in non-pregnant women is usually simple and involves antibiotic treatment for 3–5 days. Oyarzun E, The gold standard for detection of bacteriuria is urine culture, but this test is costly and takes 24 to 48 hours to obtain results. Bethesda, MD 20894, Copyright Significant bacteriuria has been historically defined as finding more than 105 colony-forming units per mL of urine.7 Recent studies of women with acute dysuria have shown the presence of significant bacteriuria with lower colony counts. Hansen KB. U.S. Preventive Services Task Force. The decision about how to screen asymptomatic women for bacteriuria is a balance between the cost of screening versus the sensitivity and specificity of each test. Gilstrap LC 3d, Cunningham FG, Whalley PJ. However, this seemingly benign condition may have serious consequences if it occurs during the course of a woman's pregnancy, and if untreated could lead to pyelonephritis, preterm labor, or Group B Streptococcal infection in the newborn. While this does not prove a cause and effect relationship, randomized trials have demonstrated that antibiotic treatment decreases the incidence of preterm birth and low-birth-weight infants.13 A risk of urosepsis and chronic pyelonephritis was also found.40 In addition, acute pyelonephritis has been associated with anemia.41, Low birth weight (weight less than 2,500 g [5 lb, 8 oz]), Prematurity (less than 37 weeks of gestation at delivery), Preterm low birth weight (weight less than 2,500 g and less than 37 weeks of gestation at delivery), Premature labor (less than 37 weeks of gestation at delivery), Amnionitis (chorioamnionitis, amnionitis). Lancet. Trimethoprim Although trimethoprim is commonly used to treat symptomatic UTIs, good evidence to support its use in pregnancy is lacking.1However, it is not thought to be teratogenic.2It is recommended that trimethoprim is avoided if possible in the first trimester because it is a folic acid antagonist and theoretically may increase the risk of neural tube defects.13 Urinary tract infection in pregnancy has three principal presentations (Box1). 1978;51:412–4. He is a co-chair of the Group on Family-centered Perinatal Care for the Society of Teachers of Family Medicine.... MICHAEL L. LEFEVRE, M.D., M.S.P.H., is professor of family and community medicine at the University of Missouri-Columbia School of Medicine, where he completed his medical degree, a residency in family medicine and a fellowship in academic medicine. Dillon HC Jr. 2016 Mar. Obstet Gynecol 1981;57:409–13. Owen J. Up to 30 percent of patients with untreated asymptomatic bacteriuria later develop symptomatic cystitis.6 Over a six-year period, Harris and Gilstrap25 found that 1.3 percent of obstetric patients who delivered at a single hospital developed acute cystitis with no symptoms of pyelonephritis. Management of urinary tract infections in adults. 27, 7, 24-24. doi: 10.7748/nop.27.7.24.e727 Scenario: UTI (no visible haematuria, not pregnant or catheterized): ; Covers the management of a suspected urinary tract infection (UTI) in women who do not have haematuria, and who are not pregnant or catheterized. Diagnosis & Management of Urinary Tract Infection (UTI) in Residential/Long Term Care/Nursing Home Residents (non-catheter associated) Diagnosis & Management of Catheter-Associated Urinary Tract Infection (CA-UTI) in Residential/Long-Term Care/Nursing Home Residents Schieve LA, Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy. Pregnant women are at an increased risk of UTIs between the 6th and 24th week of pregnancy. Rouse and colleagues14 performed a cost-benefit analysis of screening for bacteriuria in pregnant women versus inpatient treatment of pyelonephritis and found a substantial decrease in overall cost with screening. Br J Obstet Gynaecol. 10. Donnet ML, Pregnancy, pyelonephritis and prematurity. Campbell-Brown M, Symptomatic UTI occurs in 1% to 2% of pregnancies, while asymptomatic bacteriuria has been reported in 2% to 13% of pregnant women.1 Several anatomical and hormonal changes in pregnant women lead to ureteral dilatation and urinary stasis,2 which contribute to the increased risk of developing UTIs. Whalley PJ, Pregnant women are more vulnerable to getting urinary tract infections. McKenzie H, Wadland WC, This traps bacteria or causes urine to leak. Women are more likely to get UTIs than men. Handler A, Pass MA, 1987;18533591–3. Ritchie JW, Alternatively, cephalosporins are well tolerated and adequately treat the important organisms. In the 1960s, Kass6 noted the subsequent increased risk of developing pyelonephritis in patients with asymptomatic bacteriuria. Dillon HC Jr. Pass MA, Complications and treatment of urinary tract infections during pregnancy. Urinary tract infection (UTI) is a medical condition that results from the invasion and multiplication of pathogens in the urinary tract.