Chapter: Urinary Tract Infections in Pregnant Women
McMaster Section Editor(s): Mark Loeb
Section Editor(s) in Interna Szczeklika: Franciszek Kokot, Robert Drabczyk
McMaster Author(s): Dominik Mertz
Author(s) in Interna Szczeklika: Jan Duława, Robert Drabczyk
How to Cite This Chapter: Mertz D, Duława J, Drabczyk R. Urinary Tract Infections in Pregnant Women. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.14.8.7 Accessed February 17, 2019.
Last Updated: March 11, 2015
Last Reviewed: October 4, 2018
Main Documents Taken Into Account:
Guidelines on Urological Infections. European Association of Urology. Available at http://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf
. Accessed 24 March 2015.
Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
Clin Infect Dis. 2011 Mar 1;52(5):e103-20. doi: 10.1093/cid/ciq257. Review. PubMed PMID: 21292654.
Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.
Clin Infect Dis. 2010 Mar 1;50(5):625-63. PubMed PMID: 20175247.
Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
Clin Infect Dis. 2005 Mar 1;40(5):643-54. Epub 2005 Feb 4. Erratum in: Clin Infect Dis. 2005 May 15;40(10):1556. PubMed PMID: 15714408.
1. Asymptomatic bacteriuria increases the risk of acute cystitis, acute pyelonephritis, premature birth, and a low birth weight. Urine cultures should be performed at least once in the early stages of pregnancy (during the first obstetric visit or between weeks 12 and 16 of pregnancy) and treatment should be started if significant bacteriuria is detected.
Treatment according to the results of urine culture (as in cystitis) should last from 3 to 7 days. After discontinuation of treatment, follow-up urine cultures should be performed periodically to detect possible relapses (these affect a third of patients).
2. Cystitis: Diagnosis may be delayed due to the frequent occurrence of features typical for cystitis (frequency, urgency, lower abdominal discomfort) during normal pregnancy. The recommended oral treatment includes amoxicillin 500 mg tid; amoxicillin + clavulanic acid 625 mg bid; cephalexin (INN cefalexin) 250 to 500 mg qid; fosfomycin 3 g in a single dose; sulfamethoxazole/trimethoprim 960 mg bid (do not use in the first trimester or shortly before delivery).
Duration of treatment: 3 to 7 days. Urine cultures must be performed in every patient and the treatment regimen must be adjusted on the basis of the culture results.
3. Acute pyelonephritis affects from 1% to 2% of all pregnant women. It most frequently occurs during the second or third trimester due to impairment of the urinary flow. Typical clinical manifestations include high-grade fever, flank pain, frequently dysuria and vomiting (this may cause dehydration).
Treatment should be started in hospital as in acute pyelonephritis in nonpregnant patients. Note that fluoroquinolones are contraindicated in pregnant women due to their teratogenic effects.