Infection pregnancy urinary-Urinary Tract Infections During Pregnancy - American Family Physician

Initially, quizzes are posted out with journals and GPs are invited to submit their answers for CME credits. Register or Log in to take part in quizzes. Don't have an account? This item is 8 years and 6 months old; some content may no longer be current. Urinary tract infections UTIs occur commonly during pregnancy.

Infection pregnancy urinary

Infection pregnancy urinary

Other antibiotics have not been extensively researched for use in UTIs, and further studies are necessary to determine whether a shorter course of other antibiotics would be Infection pregnancy urinary effective as the traditional treatment length. 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 pregnnacy routinely obtained in pregnant women to screen for bacteriuria at the first prenatal visit and during Elite vs ford model third trimester. Medscape, Infection pregnancy urinary BladderMarch Urinary tract infections in pregnancy. Among pregnancies between andwomen filled prescriptions for nitrofurantoin in the first trimester.

Artworks gallery glass std. Understanding the urinary tract

Urinary tract infections during pregnancy. Where to go next. Risk of infections increases as males age. Pregnancy Groups. Bacterial vaginosis BV during pregnancy. As soon as you get the urge to go, go. But it seems very few people are lucky enough to have a When you hear the phrase "urinary tract infection" or its acronym, UTI, you're likely to think of a bladder infection and its accompanying symptoms — such as a frequent urge to urinate and a burning sensation when you do. However, this study has been criticized for several significant limitations including recall bias women were asked about antibiotic use after pregnancy and it was not confirmed by medical recordsinability to determine whether the birth defect was due to the antibiotic itself, the infection for which the antibiotic was prescribed, or other confounding factors. In case of persistent or recurrent Infection pregnancy urinary, longer antibiotic therapy using the same agent e. However, pregnancy greatly increases the risk of getting a kidney infection. The Cochrane Library meta-analysis revealed that antibiotic Infection pregnancy urinary was effective Sex swing mounting reducing the incidence of low-birth-weight infants but not of preterm deliveries [ 27 ]. They may develop various complications, such as acute kidney injury, anemia, hypertension, preeclampsia, sepsis and septic shock, hemolysis, thrombocytopenia, and acute Bikini model very young distress syndrome, particularly if treatment is initiated too late [ 172738 — 44 ]. Goodpasture's syndrome. Standard treatment of pyelonephritis in pregnancy involves parenteral antibacterials and intravenous hydration.

Urinary tract infections UTIs are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high.

  • One common problem during pregnancy is urinary tract infections UTIs , also known as bladder infections.
  • Urinary tract infections UTIs are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high.
  • A urinary tract infection UTI is an infection that affects part of the urinary tract.
  • When you hear the phrase "urinary tract infection" or its acronym, UTI, you're likely to think of a bladder infection and its accompanying symptoms — such as a frequent urge to urinate and a burning sensation when you do.

Your urinary tract is the perfect breeding ground for unwelcome visitors: bacteria. They multiply fast in areas being squished by your expanding uterus.

That compression — plus the muscle-relaxing properties of the hormones flooding your body and the challenge of keeping your perineal area clean due to your expanding baby belly — make it easier for the intestinal bacteria that live quietly on your skin and in your gastrointestinal tract to enter your urinary tract during pregnancy.

In many cases, you may get a urinary tract infection, or UTI, even though you experience no symptoms at all, which can cause problems if left untreated.

The urinary tract, which removes waste and extra water from the body, is made up of two kidneys, where urine is produced; two ureters, which carry urine to your bladder; the bladder itself, which collects and stores the urine; and the urethra, the tube that sends the urine out of your body. At least 5 percent of women can expect to develop at least one UTI during pregnancy; those who develop one have a 1 in 3 chance of an encore later.

That said, they're still quite rare, occurring in only about 2 percent of pregnancies. There are also some less avoidable risk factors. If any of these apply to you, be sure to discuss them with your doctor so you can be closely monitored for signs of an infection:. Think you may have a UTI? The standard way to diagnose one during pregnancy or otherwise is a urine culture. If you are diagnosed with a UTI, your doctor will likely provide a pregnancy-safe antibiotic for seven to 14 days to get rid of all of the bacteria.

If the infection has reached your kidneys, your practitioner may suggest staying in the hospital, where you can receive IV antibiotics. Keep in mind: Some women have a UTI with no symptoms at all.

Because an untreated infection can lead to complications — including kidney infection and, potentially, an increased risk of fetal growth restriction , preeclampsia and preterm birth — notify your provider immediately if you have any UTI-like symptoms. Likewise, the urine tests at your prenatal visits are really important.

Have you scheduled your next appointment yet? The educational health content on What To Expect is reviewed by our team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. This site complies with the HONcode standard for trustworthy health information. This educational content is not medical or diagnostic advice. Use of this site is subject to our terms of use and privacy policy.

Getting Pregnant. First Year. Baby Products. Reviewed March 6, What is a UTI? Several factors can lead to a UTI during pregnancy, including: Changes in your body.

Bacteria from the bowel. UTI-causing bacteria can come from several places. Because the urethra is located close to the rectum, these bacteria can be transported up the urethra. Wiping from front to back instead of back to front every time you use the bathroom can help keep bacteria away from this area. Sex during pregnancy is perfectly healthy unless your doctor tells you otherwise — but there is a downside: It also has the potential to lead to a UTI, as bacteria near the vagina including E.

Rinsing the area out in the shower afterwards also helps stave off UTIs. Group B streptococcus. This type of bacteria , commonly carried in the intestinal tract, can also cause UTIs during pregnancy.

Late in your pregnancy, your doctor will test you for this infection and treat you with antibiotics if necessary. Try to drink enough water every day; the increase in bathroom time helps flush bacteria out of the urethra. Befriend the bathroom. As soon as you get the urge to go, go. Be sure to completely expel your urine, too try leaning forward while sitting on the toilet.

Before turning in for the night, empty your bladder again. Wear cotton-crotch underwear. This will help keep that area dry, as bacteria thrive in moisture. Skip the undies when you sleep, at least sometimes if you can, to let the area air out.

Wipe from front to back. This goes for every bathroom visit. Avoid feminine hygiene products. Douches, powders, and perfumed products shower gels, soaps, sprays, detergents and toilet paper can cause irritation to an already vulnerable area. Eat well. Keep your resistance high by eating a healthy pregnancy diet and staying active.

Ask your practitioner first, though, before popping any probiotic. While it was once thought that a compound in cranberry juice could help reduce UTI recurrence, experts now say the benefit, if any, is small. Practice good hygiene. Keep your perineum meticulously clean and irritation-free by rinsing externally every time you shower showers, by the way, are better than baths.

It's also a good idea to wash the area and empty your bladder before and after sex. View Sources. Medscape, Neurogenic Bladder , March March December Your Health. Pregnancy Groups. Jump to Your Week of Pregnancy. Please whitelist our site to get all the best deals and offers from our partners. Allergies During Pregnancy. Best Maternity Leggings. Follow Us On.

Despite the diet in pregnancy is not generally different [ 96 ], we may think about some dietary approaches to change urinary pH as a prophylaxis of UTI in pregnancy. Kidney infection Bacteria may also travel from your bladder up through the ureters to infect one or both kidneys. Obstet Gynecol. Male scuba divers using condom catheters and female divers using external catching devices for their dry suits are also susceptible to urinary tract infections. Evaluation and importance of asymptomatic bacteriuria in pregnancy. The Urologic Clinics of North America. Categories : Infectious diseases Urological conditions.

Infection pregnancy urinary

Infection pregnancy urinary

Infection pregnancy urinary

Infection pregnancy urinary

Infection pregnancy urinary. Navigation menu

Risk of infections increases as males age. While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections. Urinary catheterization increases the risk for urinary tract infections. The risk of bacteriuria bacteria in the urine is between three and six percent per day and prophylactic antibiotics are not effective in decreasing symptomatic infections.

Male scuba divers using condom catheters and female divers using external catching devices for their dry suits are also susceptible to urinary tract infections. A predisposition for bladder infections may run in families.

Persons with spinal cord injury are at increased risk for urinary tract infection in part because of chronic use of catheter, and in part because of voiding dysfunction. The bacteria that cause urinary tract infections typically enter the bladder via the urethra.

However, infection may also occur via the blood or lymph. Coli are able to attach to the bladder wall and form a biofilm that resists the body's immune response. Klebsiella and Proteus spp. The presence of Gram positive bacteria such as Enterococcus and Staphylococcus increased.

The increased resistance of urinary pathogens to quinolone antibiotics has been reported worldwide and might be the consequence of overuse and misuse of quinolones. In straightforward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation.

Urine culture is deemed positive if it shows a bacterial colony count of greater than or equal to 10 3 colony-forming units per mL of a typical urinary tract organism. Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment. However, women with negative cultures may still improve with antibiotic treatment.

A urinary tract infection may involve only the lower urinary tract, in which case it is known as a bladder infection. Alternatively, it may involve the upper urinary tract, in which case it is known as pyelonephritis. If the urine contains significant bacteria but there are no symptoms, the condition is known as asymptomatic bacteriuria. To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required.

The use of "urine bags" to collect samples is discouraged by the World Health Organization due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained.

Some, such as the American Academy of Pediatrics recommends renal ultrasound and voiding cystourethrogram watching a person's urethra and urinary bladder with real time x-rays while they urinate in all children less than two years old who have had a urinary tract infection. However, because there is a lack of effective treatment if problems are found, others such as the National Institute for Health and Care Excellence only recommends routine imaging in those less than six months old or who have unusual findings.

In women with cervicitis inflammation of the cervix or vaginitis inflammation of the vagina and in young men with UTI symptoms, a Chlamydia trachomatis or Neisseria gonorrhoeae infection may be the cause. Vaginitis may also be due to a yeast infection. Hemorrhagic cystitis , characterized by blood in the urine , can occur secondary to a number of causes including: infections, radiation therapy , underlying cancer, medications and toxins.

A number of measures have not been confirmed to affect UTI frequency including: urinating immediately after intercourse, the type of underwear used, personal hygiene methods used after urinating or defecating , or whether a person typically bathes or showers. Using urinary catheters as little and as short of time as possible and appropriate care of the catheter when used prevents catheter-associated urinary tract infections.

For those with recurrent infections, taking a short course of antibiotics when each infection occurs is associated with the lowest antibiotic use. In cases where infections are related to intercourse, taking antibiotics afterwards may be useful.

The evidence that preventive antibiotics decrease urinary tract infections in children is poor. Some research suggests that cranberry juice or capsules may decrease the number of UTIs in those with frequent infections. The mainstay of treatment is antibiotics. Phenazopyridine is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection.

Those who have bacteria in the urine but no symptoms should not generally be treated with antibiotics. Uncomplicated infections can be diagnosed and treated based on symptoms alone. In the United States, urinary tract infections account for nearly seven million office visits, a million emergency department visits, and one hundred thousand hospitalizations every year.

In the United States the direct cost of treatment is estimated at 1. Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. During pregnancy, high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys.

Cephalexin or nitrofurantoin are typically used because they are generally considered safe in pregnancy. From Wikipedia, the free encyclopedia. Archived from the original on 22 February Retrieved 9 February Nature Reviews. American Family Physician. Urol Clin North Am. In a Page: Emergency medicine. Archived from the original on 24 April Emergency Medicine Clinics of North America. Clinical Medicine. Elsevier Health Sciences. Archived from the original on 16 February The Urologic Clinics of North America.

Rev Prescire. November Westport, Conn. Archived from the original on 28 May Non-vascular interventional radiology of the abdomen. New York: Springer. Archived from the original on 10 June Current Microbiology.

January Infect Control Hosp Epidemiol. Current Opinion in Infectious Diseases. Archived from the original on 9 January Retrieved 1 January Schaechter's Mechanism of Microbial Disease.

The Medical Clinics of North America. Sexual Medicine. Phipps, Simon ed. Diving and Hyperbaric Medicine. Retrieved 4 April The Cochrane Database of Systematic Reviews. The Journal of Urology. Home Healthcare Nurse. Spinal Cord. Smith et al. Archived from the original on 20 May Office urology. Totowa, N. Archived from the original on 4 May Nadel; advisor, Ron Blueprints emergency medicine 2nd ed. Archived from the original on 27 May Graham, Thomas E.

Glenn's urologic surgery 7th ed. Philadelphia, Pa. Barry Belman; Lowell R. King; Stephen A. Clinical pediatric urology 4. London: Dunitz. Archived from the original on 15 May A Systematic Review and Meta-Analysis". Bibcode : PLoSO Clark, Luigi X. Pharmacology 4th ed. Archived from the original on 9 June Use of this site is subject to our terms of use and privacy policy.

Getting Pregnant. First Year. Baby Products. Reviewed March 6, What is a UTI? Several factors can lead to a UTI during pregnancy, including: Changes in your body. Bacteria from the bowel. UTI-causing bacteria can come from several places. Because the urethra is located close to the rectum, these bacteria can be transported up the urethra. Wiping from front to back instead of back to front every time you use the bathroom can help keep bacteria away from this area. Sex during pregnancy is perfectly healthy unless your doctor tells you otherwise — but there is a downside: It also has the potential to lead to a UTI, as bacteria near the vagina including E.

Rinsing the area out in the shower afterwards also helps stave off UTIs. Group B streptococcus. This type of bacteria , commonly carried in the intestinal tract, can also cause UTIs during pregnancy. Late in your pregnancy, your doctor will test you for this infection and treat you with antibiotics if necessary.

Try to drink enough water every day; the increase in bathroom time helps flush bacteria out of the urethra. Befriend the bathroom. As soon as you get the urge to go, go. Be sure to completely expel your urine, too try leaning forward while sitting on the toilet. Before turning in for the night, empty your bladder again. Wear cotton-crotch underwear. This will help keep that area dry, as bacteria thrive in moisture.

Skip the undies when you sleep, at least sometimes if you can, to let the area air out. Wipe from front to back. This goes for every bathroom visit. Avoid feminine hygiene products. Douches, powders, and perfumed products shower gels, soaps, sprays, detergents and toilet paper can cause irritation to an already vulnerable area. Eat well. Keep your resistance high by eating a healthy pregnancy diet and staying active.

Ask your practitioner first, though, before popping any probiotic. While it was once thought that a compound in cranberry juice could help reduce UTI recurrence, experts now say the benefit, if any, is small.

Practice good hygiene.

Urinary Tract Infection In Pregnancy - StatPearls - NCBI Bookshelf

Urinary tract infections UTIs are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high. Pregnancy is a state associated with physiological, structural and functional urinary tract changes which promote ascending infections from the urethra.

Unlike the general population, all pregnant women should be screened for bacteriuria with urine culture, and asymptomatic bacteriuria must be treated in every case that is diagnosed, as it is an important risk factor for pyelonephritis in this population.

The antibiotic chosen should have a good maternal and fetal safety profile. In this paper, current principles of diagnosis and management of UTI in pregnancy are reviewed, and the main problems and controversies are identified and discussed. Urinary tract infections UTIs in pregnant women continue to pose a clinical problem and a great challenge for physicians. That is related to profound structural and functional urinary tract changes, typical for pregnancy.

This may be due to high levels of circulating progesterone [ 1 , 7 ]. Simultaneously, the enlarged uterus compresses the urinary bladder, thus increasing the intravesical pressure, which may result in vesico-ureteral reflux and urine retention in the bladder after miction, commonly observed in pregnant women.

Urinary stasis and impairment of the physiological anti-reflux mechanism create conditions favorable for bacterial growth and ascending infection. The additional predisposing factors include pregnancy-specific biochemical changes in urine, with higher amounts of glucose, amino acids and hormone degradation products, which increase urinary pH [ 7 , 8 ].

Similarly as in non-pregnant women, in pregnant women UTIs are classified either as asymptomatic bacteriuria ASB , when the infection is limited to bacterial growth in urine, or symptomatic infections acute cystitis, acute pyelonephritis , when bacteria invade urinary tract tissues, inducing an inflammatory response.

The UTIs in pregnancy are by definition considered complicated infections and require a special diagnostic approach and management. Many women acquire bacteriuria before pregnancy [ 18 , 19 ]. Other suggested risk factors for UTI during pregnancy are lower socioeconomic status, sexual activity, older age, multiparity, anatomical urinary tract abnormalities, sickle cell disease and diabetes, although the significance of some of them age, parity or sickle cell trait remains a matter of controversy [ 1 , 10 , 21 — 23 ].

The pathogens responsible for infections during pregnancy are similar to those in the general population. The Cochrane Library meta-analysis revealed that antibiotic treatment was effective in reducing the incidence of low-birth-weight infants but not of preterm deliveries [ 27 ]. However, the authors stressed the poor methodological quality of the available studies, their different design, lack of sufficient information about the randomization methods, different definitions used, low statistical power and some substantial biases, urging caution in drawing conclusions.

A good example of these problems is presented by the Cardiff Birth Survey [ 33 ]. In a prospectively studied large cohort of 25 pregnancies, several demographic, social and medical factors including bacteriuria were significantly associated with preterm birth in the initial univariable analyses.

However, after adjustments for other medical factors, bacteriuria retained an association of only borderline significance, and after further adjustment for demographic and social factors, the relationship completely disappeared. Two separate multiple logistic regression analyses revealed that spontaneous and indicated preterm births have different overall profiles of risk factors, and only the last of them was associated with bacteriuria.

Maternal GBS bacteriuria in a pregnant woman is considered a marker for genital tract colonization with this organism which poses a significant risk of preterm rupture of the membranes, premature delivery and early-onset severe neonatal infection [ 1 , 24 , 26 , 35 — 37 ].

They may develop various complications, such as acute kidney injury, anemia, hypertension, preeclampsia, sepsis and septic shock, hemolysis, thrombocytopenia, and acute respiratory distress syndrome, particularly if treatment is initiated too late [ 17 , 27 , 38 — 44 ].

A number of observational studies have demonstrated the relationship between maternal symptomatic UTI and the risk of premature delivery and lower birth weight [ 28 — 30 , 46 ]. However, again, a substantial heterogeneity between these studies, together with many possible biases, makes it difficult to establish the overall contribution of UTI to preterm birth [ 48 ].

A rare but severe complication is the transmission of the infection onto the newborn baby [ 49 ]. Very often the transmitted infection originates from a heavily colonized birth canal, usually with GBS [ 26 ]. Nearly all antimicrobials cross the placenta, and some of them may exert teratogenic effects.

A — Well-controlled studies available in humans with no adverse effects observed in human pregnancies; B — No adverse effects in well-controlled studies of human pregnancies with adverse effects seen in animal pregnancies OR no adverse effects in animal pregnancies without well-controlled human pregnancy data available; C — Human data lacking with adverse pregnancy effects seen in animal studies OR no pregnancy data available in either animals or humans; D — Adverse effects demonstrated in human pregnancies; benefits of drug use may outweigh the associated risks.

However, this study has been criticized for several significant limitations including recall bias women were asked about antibiotic use after pregnancy and it was not confirmed by medical records , inability to determine whether the birth defect was due to the antibiotic itself, the infection for which the antibiotic was prescribed, or other confounding factors. Recently Nordeng et al. Among pregnancies between and , women filled prescriptions for nitrofurantoin in the first trimester.

The same concerns other antimicrobials with very high protein binding e. Nitrofurantoin can be theoretically associated with a risk of fetal or neonatal hemolytic anemia if the mother has glucosephosphate deficiency, and although this complication in pregnancy has not been reported, the drug should be used with caution, particularly in areas of disease prevalence [ 10 , 58 , 59 ].

The rate of major congenital malformations did not differ between the group exposed to quinolones in the first trimester and the control group 2. A systemic review of prospective, controlled studies showed that the use of fluoroquinolones during the first trimester of pregnancy does not appear to be associated with an increased risk of major malformations recognized after birth, stillbirths, preterm births or low birth weight [ 64 ].

However, in some cases of complicated symptomatic UTI, resistant to other antibiotics, their benefits may outweigh the risks [ 60 ]. Although these drugs are used in pregnancy relatively often, the data on their embryotoxicity and teratogenicity are limited.

No significant teratogenic effect of erythromycin was identified in a Hungarian case-control study, a nationally based registry of cases with congenital abnormalities [ 69 ]. The main limitations of this data set were: a relatively low response rate, retrospective collection of data recall bias , inability to exclude the effect of other drugs, and a restriction of the study to the second and third trimester.

However, in a large prospective observational study, performed in women exposed to macrolides during the first trimester, Bar-Oz et al. Recently, Lin et al. In logistic regression analysis they found no association of exposure to the drugs and increased risk of both types of birth defects.

So further studies are needed before the macrolides become accepted for wide use. Until then, this group of antibiotics should be reserved for the treatment of serious or life-threatening conditions, unresponsive to standard antibiotic therapy. The study sought follow-up information for children at age 7 in the UK using a parent-report postal questionnaire.

The cause of this neurological dysfunction is unclear, but it could be a result of subclinical perinatal infection as well as a direct effect of the antibiotics on the fetal brain or cerebral blood flow. Alternatively the antibiotic might have negatively influenced microbial colonization of newborn children, with long-lasting consequences.

There are some suggestions that antibiotics alter immune tolerance by changing the fetal gut flora, thus contributing to the substantial increase in the incidence of asthma, allergies, autoimmune diseases, autism, ADHD and other chronic conditions [ 73 — 75 ].

The main conclusion from all these interesting studies is that we should be very cautious in prescribing antibiotics to pregnant women in the absence of proven benefit e. Given the evidence that effective antimicrobial therapy of ASB in pregnancy significantly reduces the risk of pyelonephritis and possibly also adverse fetal outcomes, routine screening for the presence of clinically significant bacteriuria in all pregnant women has become necessary.

A question which remains unanswered is: should women in whom no ASB was detected upon the first examination have additional screening in later pregnancy? McIsaac et al.

A total of 49 cases of ASB were detected prevalence 4. In a much smaller Turkish study, ASB prevalence distribution in the first, second, and third trimesters was 0. That suggests that many women with no bacteriuria in their initial examination in the first trimester may develop bacteriuria during the later trimesters. The authors of these studies conclude that it would be prudent to screen pregnant women for bacteriuria also in the second and third trimesters [ 78 , 79 ].

However, until large, prospective, randomized clinical trials RCTs are available and a clear benefit of this routine additional screening is observed, no recommendation can be made for or against it. The presence of ASB in a pregnant woman is an absolute indication for initiation of the treatment. Management of ASB in pregnancy consists of short-term, usually 5—7 days, oral antibiotic therapy [ 76 ]. Basic principles of management are presented in Table II.

In the face of the rapidly developing antibiotic resistance, the current position is that the treatment should be based on microbial sensitivity testing. Kashanian et al. Out of 10 cultures in which E. All pregnant women with ASB should have periodic screening after therapy, since as many as one third of them experience a recurrent infection [ 58 , 76 ]. Follow-up cultures should be obtained 1—2 weeks after treatment and then repeated once a month [ 58 , 76 ]. In case of persistent or recurrent bacteriuria, longer antibiotic therapy using the same agent e.

Subsequent treatment courses are administered until the bacterial counts drop to non-significant levels [ 56 ]. If bacteriuria persists despite repeated courses of therapy, as well as in women with additional risk factors e.

Patients with recurrences associated with sexual activity may be offered postcoital prophylaxis a single antibiotic dose e. The remaining women may be given small doses of antibacterial agents e. In this group the follow-up urine culture is performed only at the beginning of the third trimester. In case of significant bacteriuria, prophylactic doses should be replaced by another course of antimicrobials, based on susceptibility testing [ 56 ].

The optimal duration of treatment is unknown, but longer courses 5—7 days of the therapy are generally suggested [ 12 , 55 , 58 , 86 ]. In women receiving chronic immunosuppression, management discussed in the section on ASB should be followed. Besides ASB, the other risk factors of acute pyelonephritis include: mother's age, nulliparity, sickle cell anemia, diabetes, nephrolithiasis, illicit drug use, history of pyelonephritis and maternal urinary tract defects [ 2 , 8 , 24 , 58 ].

Nearly one in five of pregnant women with pyelonephritis has septicemia at diagnosis [ 3 , 8 , 17 , 40 ]. Hill et al.

Numbers of preterm births and small-for-gestational-age infants were not increased as compared with expected rates in this hospital. Basic principles of management are presented in Table III. According to the IDSA guidelines, all suspected cases of pyelonephritis should be hospitalized at least for the initial 48 h of treatment [ 76 ].

However, some authors believe that in carefully selected cases, when a definite diagnosis of pyelonephritis can be made and a strict medical follow-up is possible, outpatient treatment may be attempted [ 38 , 88 , 89 ].

Appropriate hydration of the patient is a very important part of the treatment regardless of the setting. Beside urine and blood culture, recommendations include basic laboratory analyses complete blood counts, electrolytes, creatinine, liver parameters, coagulation profile and an ultrasound scan, which usually reveals dilation of pyelocalyceal systems and allows exclusion of other causes of the symptoms e.

In all patients, regardless of whether they are hospitalized, antibiotics should be given parenterally, for at least the first 48 h until the resolution of fever. Forty-eight hours after resolution of symptoms, administration may be switched to the oral route.

Antibiotic therapy is usually continued for 10—14 days, although its optimum duration has never been established. Unfortunately, there are not sufficient data available to recommend the specific treatment regimens in pregnant women. Then upon detection of bacteriuria, prophylaxis is replaced by regular treatment [ 56 ].

In the aforementioned prospective study by Hill et al. Only 12 of them 2. However, again, this regimen is not supported by evidence obtained in RCTs. Due to the potential risk to mother and fetus, detection and effective treatment of UTIs remains an important clinical problem.

It is advisable to assess risk factors for UTI in pregnancy, bearing in mind that some diagnostic procedures are not feasible and advisable to perform i. Unfortunately, in contrast to the overall population, available data are scant, and the management guidelines were published several years ago and were largely opinion-based.

The development of new recommendations requires well-planned, extensive studies, that would answer the still open questions regarding the frequency of screening and follow-up examinations, purposefulness of prophylaxis, safety of hitherto insufficiently studied or new antibiotics in pregnancy, and choice of optimum treatment regimens. If possible, any antibiotic use should be avoided in the first trimester, as this is the period of fetal organogenesis and nervous system development, with the highest risk of teratogenic effects of drugs.

Another disturbing problem, particularly in the aspect of fetal safety associated with therapeutic limitations, is the observed rapid development of antibiotic resistance.

Infection pregnancy urinary