Pregnancy and bacteriuria
Between 2 and 10 percent of pregnancies are complicated by UTIs; if left untreated, 25 to 30 percent of these women develop pyelonephritis. Pregnancies that are complicated by pyelonephritis have been associated with low-birth-weight infants and prematurity. Thus, pregnant women should be screened for bacteriuria by urine culture at 12 to 16 weeks of gestation. The presence of 100,000 CFU of bacteria per mL of urine is considered significant. Pregnant women with asymptomatic bacteriuria should be treated with a three- to seven-day course of antibiotics, and the urine should subsequently be cultured to ensure cure and the avoidance of relapse. Although amoxicillin is frequently suggested as the agent of choice, E. coli is now commonly resistant to ampicillin, amoxicillin and cephalexin. Thus, treatment should be based on the results of susceptibility tests. Nitrofurantoin or trimethoprim-sulfamethoxazole may also be used; however, caution should be exercised in the third trimester because the sulfonamides compete with bilirubin binding in the newborn. Symptomatic urinary tract infections complicate 1 to 2 percent of pregnancies, usually in women with persistent bacteriuria. Most pregnant women with pyelonephritis should be hospitalized. Initially, these patients should receive intravenous antibiotic therapy. They should complete a 14-day course of acute antibiotic therapy followed by nightly suppressive therapy until delivery. Recent studies have shown that selected pregnant women with pyelonephritis can be treated with either outpatient intramuscularly administered ceftriaxone (Rocephin) or orally administered cephalexin. Ceftriaxone, a third-generation parenterally administered cephalosporin, is a suitable agent for inpatient treatment. Tetracyclines and fluoroquinolones should be avoided in pregnancy.
Pyelonephritis is a significant complication of UTI in pregnancy Associated with LBW/and prematurity.
Screening urine culture at 12-16 weeks of gestation.
>100,000 CFU/ml is significant.
Agent of choice amoxicillin.
TMP SMX to be avoided in 3rd trimestor.
Hospitalization is indicated in pyelonephritis.
IV Ceftriaxone drug of choice in hospitalised patients.
Avoid Tetracycline and Fluroquinolones in pregnancy.
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Comments
for urinary problem which doctor shall I contact Medicine or Urologist
I have UTI generally recurring. Last time I had around a years back and got treated with Ofloxacin for about 15 days. Today I am suffering for very frequent urination with sensation and unable to control. Kindly suggest some medicine.
First UTI in over 10 yrs. Unfortunately I've had over a month of UTI symptoms. The first two urine specimens were [ ] for blood, WBC, and bacteria but were NEVER cultured. I went through two different rounds of antibiotics. Symptoms still there. My doctors were saying obviously it isn't an UTI, that it must be stress or something else. We'll finally after suffering a month, the next urine sample WAS cultured and it came back I have coagulase negative staph. And get this, the bacteria is resistant to most antibiotics, including penicillin, Levaquin, Sulfa, and Cipro. I'm not so sure not culturing a positive urine sample is such a great idea. I know I have greatly suffered. I'm now on macrobid and hoping this will take care of it.
I have a recalled bladder sling and I have been having recurring UTI synptoms. Nitrites and leukocytes are always present, but cultures grow nothing. I am at a loss and so is my Dr. I am seeing a specialist at Vanderbilt and he is removing the sling in a couple of weeks. Anyone else have this issue?
i have found that UTIs with no symptoms should not be treated especially if they have ESBL or KPC.
A well known case ESBL to me I stoped treating her with antibiotics works now well for more than 8 months