Chapter 11: Infections: UTI

Question 1

Urinary Tract Infection (UTI)

Answer 1

• most common bacterial infection in pregnancy

- most common infecting organism = Escherichia coli (E. coli)

Question 2

Pathophysiology

Answer 2

dilation of the urinary collecting system that occurs normally during pregnancy is associated with an increase in ascending urinary infections
-mechanical and hormonal changes may lead to hydroureter, decreased peristalsis, bladder distention, and incomplete emptying; can result in urine stasis or reflux in the bladder and ureters

Question 3

Morbidity

Answer 3

bacteriuria in pregnancy predisposes that patient to the development of acute pyelonephritis, a condition that poses risk to the woman and fetus
-asymptomatic and untreated bacteriuria is associated with low birth weight, intrauterine death, preeclampsia, and maternal anemia

Question 4

Asymptomatic Bacteriuria

Answer 4

presence of at least 10^5 colony-forming units of bacteria per mL of clean, voided, midstream urine obtained on 2 separate occasions
-Treatment: anti-infectives such as ampicillin for a 7 to 10 day period; a 3 day course may be effective

Question 5

Acute Cystitis

Answer 5

symptomatic lower UTI

• symptoms: urinary frequency, urgency, dysuria, and suprapubic pain
• Treatment: anti-infectives such as ampicillin for a 7 to 10 day course; a 3 day course may be effective

Question 6

Acute Pyelonephritis

Answer 6

inflammation of the kidney substance and pelvis
-presents as flank tenderness on the affected side
-nausea, vomiting, fever, and chills along with symptoms of urinary frequency, urgency, dysuria, and suprapubic pain
-Treatment: aggressively with hospitalization and IV antibiotics
>if left untreated, septic shock, adult respiratory distress syndrome, and/or PTL

Question 7

When caring for a Patient with a UTI

Answer 7

-a urine specimen is more likely to be contaminated by bacteria that originate in the urethra, vagina, or perineum
>this occurs because of the change in pH during pregnancy: the urine becomes more alkaline as a result of the maternal excretion of bicarbonate
-the vagina also becomes alkaline and the vaginal secretions have increased glycogen content, which aids in bacterial growth
>urinalysis and urine culture and sensitivity should be obtained on all patients who present with preterm labor and signs of UTI often mimic normal pregnancy complaints (e.g. urgency, frequency)
>complete all medication prescribed even if symptoms subside
-a test of cure (repeat urine test to evaluate whether bacteria are still present)

Question 8

Group B Streptococcal Infection (GBS)

Answer 8

frequent cause of UTIs and chorioamnionitis during pregnancy
-cause of endometritis after pregnancy has ended
-it is a major pathogen in neonatal sepsis that can result in neonatal morbidity and mortality
>women harbor GBS as part of normal fecal and vaginal flora
>infants with early onset develop signs (e.g. respiratory distress, septic shock) during first 12 hours of life
>exposure occurs in utero or during labor as fetus travels down the colonized birth canal
>Risk Factors: prematurity, low birth weight, premature rupture of membranes (PROM), prolonged labor, maternal chorioamnionitis, multiple gestation, and GBS bacteremia during pregnancy
>late onset GBS is community acquired

Question 9

How to Protect Infants from Group B Streptococcal Infection (GBS)

Answer 9

obtain vaginal and rectal cultures from women between 35 and 37 weeks of pregnancy
-women with positive cultures, those with unknown GBS at the onset of labor, delivery at less than 37 weeks of gestation, ruptured membranes greater than or equal to 18 hours, or an intrapartum temperature greater than or equal to 100.4 degrees F are treated with a penicillin-based anti-infective agent