Urinary tract infection and bacteriuria in pregnancy Flashcards
How common is UTI in pregnancy?
1 in 25 affected
Why is UTI more common in pregnancy?
Women are at increased risk of UTI because of renal tract dilatation leading to urinary stasis
Pyelonephritis is common at around 20 weeks and in the puerperium
What are the risk factors for UTI?
- History of recurrent cystitis
- Renal tract abnormalities: duplex system, scarred kidneys, ureteric damage and stones.
- Diabetes
- Bladder emptying problems (e.g. multiple sclerosis)
What is the first line antibiotic for UTI in pregnancy?
Nitrofurantoin - but avoid this at full term
Why must nitrofurantoin be avoided in pregnancy at full term?
Causes neonatal haemolysis
Why should trimethorpim be avoided in pregnancy?
Teratogenic in the first trimester and should be avoided during pregnancy
What are the clinical features of UTI in pregnancy?
Usual symptoms:
- urinary frequency
- urinary urgency
- dysuria
- cloudy/offensive smelling urine
- lower abdominal pain
- fever: typically low-grade in lower UTI
- malaise
In pregnancy: lower back pain with general malaise and flu-like symptoms. O/E: tachycardia, pyrexia, dehydration, loin tenderness.
What are the most common organisms causing UTI?
- Escherichia coli (most common)
- Less commonly: streptococci, Proteus, Pseudomonas and Klebsiella spp.
How does the laboratory define UTI?
Presence of >105 CFU/ml
What does a report of ‘heavy mixed growth’ indicate in UTI?
- Means no predominating organism causing UTI
- Often associated with symptomatic UTI
- May be treated immediately or MSU repeated after a week depending on clinical scenario
What are the clinical features of acute pyelonephritis?
- fever (>38.5), rigors
- loin pain
- vomiting
- white cell casts in urine
- deydration
- shock (rarely)
What are the antibiotic options for UTI in pregnancy?
1st line: nitrofurantoin 50mg QDS or 100mg modified release BD for 7 days
2nd line:
- amoxicillin 500mg TDS 7 days - only if culture results show susceptibility OR
- cefalexin 500mg BD 7 days
What outcomes is UTI in pregnanacy associated with?
- IUGR - due to reduced levels of maternal plasma protein Z
- Risk of pre-term delivery
- Fetal death
What is the management of symptomatic bacteruria in pregnancy?
- Send urine culture in ALL cases
- Antibiotic treatment
- Advise to take paracetamol + hydrate with plenty of clear fluids
NB: recurrent UTI in pregnancy warrants MSU specimens to be sent at each antenatal visit and prescription of low-dose prophylactic antibiotics. Investigate for causes after delivery unless frank haematuria or other symptoms suggest that diagnosis is essential.
What is the management of asymptomatic bacteruria in pregnancy?
- Send urine culture at the first antenatal visit as routine
- Immediate antibiotic (as normal for 7 days)
- Send urine culture for a test of cure after treatment
NB: recurrent UTI in pregnancy warrants MSU specimens to be sent at each antenatal visit and prescription of low-dose prophylactic antibiotics. Investigate for causes after delivery unless frank haematuria or other symptoms suggest that diagnosis is essential e.g. DMSA function scan, Cr clearance, IV urogram and cystoscopy.
