Urinary tract infections (UTIs) are one of the most common infections in pregnancy, occurring in about 8% of all pregnancies and range from asymptomatic bacteriuria to acute pyelonephritis. They are associated with adverse pregnancy outcomes such as preterm birth and low birth weight, therefore the timely identification and treatment of these is essential. Anatomic changes during pregnancy increase the risk for UTIs, such as ureteral dilation, the mechanical compression of ureters by the uterus causing urinary stasis, contributing to bacteria colonization and ascending infection. E coli remains the most common identified pathogen. Given the high rates of antibiotic resistance to this organism, the selection of first line therapy must avoid antibiotics such as amoxicillin and ampicillin. Treatment of symptomatic bacteriuria decreases the risk of pyelonephritis, which can cause significant maternal complications such as DIC and ARDS, as well as fetal complications such as preterm birth. Patients with hemoglobinopathy have higher rates of cystitis and asymptomatic bacteriuria. ACOG provides recommendations regarding urinary tract infection in pregnancy.
Asymptomatic Bacteriuria (ASB)
Note: Low risk for anaphylaxis, cephalosporin treatment is appropriate | High risk for anaphylaxis should be treated with alternative regimen
Acute Cystitis
Pyelonephritis
Note: Remain suspicious even if only some of the above is present (e.g., fever and UTI)
ACOG Clinical Consensus 4: Urinary Tract Infections in Pregnant Individuals
Acute uncomplicated cystitis is often readily recognized by patients as a routine bladder infection. Uncomplicated cystitis rarely progresses to pyelonephritis and urosepsis even if untreated. The primary goal of treatment is to relieve symptoms. If a patient presents with pain, urgency and frequent urination
Note: The following recommendations apply to nonpregnant women | There has been concern regarding the use of nitrofurantoin and sulfonamides in the first trimester due to possible risk for birth defects
Note: FDA recommends the following
FDA has approved label changes that reserve the use of fluoroquinolone antibacterial medicines when treating acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) for patients who do not have alternative treatment options
UTI is the most common infection encountered in the outpatient setting. By age 32, half of all women will have had at least one UTI. Recurrence rates are over 25%. Fluoroquinolones are effective, but the recommendation is to avoid as a first-line medication to prevent future resistance and maintain these medications as a second-line treatment when needed.
CDC: Adult Outpatient Treatment Recommendations | Antibiotic Use
ACP: Appropriate Use of Short-Course Antibiotics in Common Infections
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