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Urinary Tract Infections

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Perinatology

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Abstract

Urinary tract infections (UTI) in pregnancy, usually diagnosed based on findings of bacteriuria ≥105 colony-forming units per mL of urine, are a risk factor for maternal and fetal adverse outcomes. They are usually classified as either symptomatic or asymptomatic.

Asymptomatic bacteriuria (ASB) is defined as the presence of significant bacterial growth in urine culture in the absence of UTI symptoms. Cystitis represents bladder involvement and is typically accompanied by dysuria, urgency, and frequent urination. Pyelonephritis, the upper urinary tract infection, is usually accompanied by typical clinical manifestations such as fever, flank pain, sensitivity in the costovertebral angle, nausea, and vomiting.

In pregnancy, ASB is associated with an increased risk of pyelonephritis, which may cause severe morbidity for mother and fetus. The primary maternal complications are septic shock syndrome, disseminated intravascular coagulation, renal failure, and acute respiratory distress syndrome. Obstetric adverse outcomes include preterm delivery and low birth weight.

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References

  1. Sobel JD. Pathogenesis of urinary tract infection. Role of host defenses. Infect Dis Clin N Am. 1997;11(3):531–49. https://doi.org/10.1016/s0891-5520(05)70372-x.

    Article  CAS  Google Scholar 

  2. Neal DE Jr. Host defense mechanism in urinary tract infections. Urol Clin North Am. 1999;26(4):677–86. https://doi.org/10.1016/s0094-0143(05)70210-x.

    Article  Google Scholar 

  3. Santos JF, Ribeiro RM, Rossi P, Haddad JM, Guidi HG, Pacetta AM, et al. Urinary tract infections in pregnant women. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(3):204–9. https://doi.org/10.1007/s192-002-8354-7.

    Article  CAS  Google Scholar 

  4. Kalinderi K, Delkos D, Kalinderis M, Athanasiadis A, Kalogiannidis I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J Obstet Gynaecol. 2018;38(4):448–53. https://doi.org/10.1080/01443615.2017.1370579.

    Article  Google Scholar 

  5. Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiol Spectr. 2016;4(5). https://doi.org/10.1128/microbiolspec.UTI-0002-2012.

  6. Thadhani RI, Maynard SE. Maternal adaptations to pregnancy: renal and urinary tract physiology. In: Post TW, editor. UpToDate. Waltham: UpToDate Inc. https://www.uptodate.com. Accessed on 30 Apr 2020.

  7. Glaser AP, Schaeffer AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin North Am. 2015;42(4):547–60. https://doi.org/10.1016/j.ucl.2015.05.004.

    Article  Google Scholar 

  8. Alto WA. No need for glycosuria/proteinuria screen in pregnant women. J Fam Pract. 2005;54(11):978–83.

    Google Scholar 

  9. Petersson C, Hedges S, Stenqvist K, Sandberg T, Connell H, Svanborg C. Suppressed antibody and interleukin-6 responses to acute pyelonephritis in pregnancy. Kidney Int. 1994;45(2):571–7. https://doi.org/10.1038/ki.1994.74.

    Article  CAS  Google Scholar 

  10. Schwartz MA, Wang CC, Eckert LO, Critchlow CW. Risk factors for urinary tract infection in the postpartum period. Am J Obstet Gynecol. 1999;181(3):547–53. https://doi.org/10.1016/s0002-9378(99)70491-6.

    Article  CAS  Google Scholar 

  11. Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2019;2019(11) https://doi.org/10.1002/14651858.CD000490.pub4.

  12. Nicolle LE. Management of asymptomatic bacteriuria in pregnant women. Lancet Infect Dis. 2015;15(11):1252–4. https://doi.org/10.1016/S1473-3099(15)00145-0.

    Article  Google Scholar 

  13. Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014;210(3):219.e1–6. https://doi.org/10.1016/j.ajog.2013.10.006.

    Article  Google Scholar 

  14. Hooton TM, Gupta K. Urinary tract infections and asymptomatic bacteriuria in pregnancy. In: Post TW, editor. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com Accessed on 25 Apr 2020.

  15. Millar LK, Cox SM. Urinary tract infections complicating pregnancy. Infect Dis Clin N Am. 1997;11(1):13–26. https://doi.org/10.1016/s0891-5520(05)70339-1.

    Article  CAS  Google Scholar 

  16. Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriúria in pregnancy. Update in the managed health care era. Infect Dis Clin N Am. 1997;11(3):593–608. https://doi.org/10.1016/s0891-5520(05)70375-5.

    Article  CAS  Google Scholar 

  17. Abou Heidar NF, Degheili JA, Yacoubian AA, Khauli RB. Management of urinary tract infection in women: a practical approach for everyday practice. Urol Ann. 2019;11(4):339–46. https://doi.org/10.4103/UA.UA_104_19.

    Article  Google Scholar 

  18. Lüthje P, Brauner A. Virulence factors of uropathogenic E. coli and their interaction with the host. Adv Microb Physiol. 2014;65:337–72. https://doi.org/10.1016/bs.ampbs.2014.08.006.

    Article  CAS  Google Scholar 

  19. Armbruster CE, Mobley HLT, Pearson MM. Pathogenesis of Proteus mirabilis infection. EcoSal Plus. 2018;8(1). https://doi.org/10.1128/ecosalplus.ESP-0009-2017.

  20. Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol. 2018;219(1):40–51. https://doi.org/10.1016/j.ajog.2017.12.231.

    Article  Google Scholar 

  21. LaRocco MT, Franek J, Leibach EK, Weissfeld AS, Kraft CS, Sautter RL, et al. Effectiveness of preanalytic practices on contamination and diagnostic accuracy of urine cultures: a laboratory medicine best practices systematic review and meta-analysis. Clin Microbiol Rev. 2016;29(1):105–47. https://doi.org/10.1128/CMR.00030-15.

    Article  Google Scholar 

  22. Henderson JT, Webber EM, Bean SI. Screening for asymptomatic bacteriuria in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2019;322(12):1195–205. https://doi.org/10.1001/jama.2019.10060.

    Article  Google Scholar 

  23. Nicolle LE. Updated guidelines for screening for asymptomatic bacteriuria. JAMA. 2019;322(12):1152–4. https://doi.org/10.1001/jama.2019.11640.

    Article  Google Scholar 

  24. Wingert A, Pillay J, Sebastianski M, Gates M, Featherstone R, Shave K, et al. Asymptomatic bacteriuria in pregnancy: systematic reviews of screening and treatment effectiveness and patient preferences. BMJ Open. 2019;9(3):e021347. https://doi.org/10.1136/bmjopen-2017-021347.

    Article  Google Scholar 

  25. Allen VM, Yudin MH. No. 276-Management of Group B streptococcal bacteriuria in pregnancy. J Obstet Gynaecol Can. 2018;40(2):e181–6. https://doi.org/10.1016/j.jogc.2017.11.025.

    Article  Google Scholar 

  26. Mittal P, Wing DA. Urinary tract infections in pregnancy. Clin Perinatol. 2005;32(3):749–64. https://doi.org/10.1016/j.clp.2005.05.006.

    Article  Google Scholar 

  27. Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028–37. https://doi.org/10.1056/NEJMcp1104429.

    Article  CAS  Google Scholar 

  28. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, 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;52(5):e103–20. https://doi.org/10.1093/cid/ciq257.

  29. Vazquez JC, Villar J. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst Rev. 2003;(4):CD002256. Review. Update in: Cochrane Database Syst Rev. 2011;(1):CD002256. https://doi.org/10.1002/14651858.CD002256.

  30. Keating GM. Fosfomycin trometamol: a review of its use as a single-dose oral treatment for patients with acute lower urinary tract infections and pregnant women with asymptomatic bacteriuria. Drugs. 2013;73(17):1951–66.

    Article  CAS  Google Scholar 

  31. Ho PL, Yip KS, Chow KH, Lo JY, Que TL, Yuen KY. Antimicrobial resistance among uropathogens that cause acute uncomplicated cystitis in women in Hong Kong: a prospective multicenter study in 2006 to 2008. Diagn Microbiol Infect Dis. 2010;66(1):87.

    Article  CAS  Google Scholar 

  32. Soytas M, Kactan C, Guven S. Recurrent bladder cystitis: who takes the role? World J Urol. 2020; https://doi.org/10.1007/s00345-020-03192-1.

  33. Cunningham FG, Lucas MJ. Urinary tract infections complicating pregnancy. Baillieres Clin Obstet Gynaecol. 1994;8(2):353–73. https://doi.org/10.1016/s0950-3552(05)80325-6.

    Article  CAS  Google Scholar 

  34. Gomi H, Goto Y, Laopaiboon M, Usui R, Mori R. Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Cochrane Database Syst Rev. 2015;(2):CD009216. https://doi.org/10.1002/14651858.CD009216.pub2.

  35. Colgan R, Williams M, Johnson JR. Diagnosis and treatment of acute pyelonephritis in women. Am Fam Physician. 2011;84(5):519–26.

    Google Scholar 

  36. Jolley JA, Wing DA. Pyelonephritis in pregnancy: an update on treatment options for optimal outcomes. Drugs. 2010;70(13):1643–55. https://doi.org/10.2165/11538050-000000000-00000.

    Article  CAS  Google Scholar 

  37. Johnson JR, Russo TA. Acute pyelonephritis in adults. N Engl J Med. 2018;378(1):48–59. Review. Erratum in: N Engl J Med. 2018 Mar 15;378(11):1069. https://doi.org/10.1056/nejmcp1702758.

    Article  Google Scholar 

  38. Bookstaver PB, Bland CM, Griffin B, Stover KR, Eiland LS, McLaughlin M. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015;35(11):1052–62. https://doi.org/10.1002/phar.1649.

    Article  CAS  Google Scholar 

  39. Greer LG, Roberts SW, Sheffield JS, Rogers VL, Hill JB, Mcintire DD, et al. Ampicillin resistance and outcome differences in acute antepartum pyelonephritis. Infect Dis Obstet Gynecol. 2008;2008:891426. https://doi.org/10.1155/2008/891426.

    Article  CAS  Google Scholar 

  40. Bader MS, Loeb M, Brooks AA. An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 2017;129(2):242–58. https://doi.org/10.1080/00325481.2017.1246055.

    Article  Google Scholar 

  41. Lamont HF, Blogg HJ, Lamont RF. Safety of antimicrobial treatment during pregnancy: a current review of resistance, immunomodulation and teratogenicity. Expert Opin Drug Saf. 2014;13(12):1569–81. https://doi.org/10.1517/14740338.2014.939580.

    Article  CAS  Google Scholar 

  42. Carraro-Eduardo JC, Oliveira AV, Carrapatoso ME, Ornellas JF. Effect of sex hormones on gentamicin-induced nephrotoxicity in rats. Braz J Med Biol Res. 1993;26(6):653–62.

    CAS  Google Scholar 

  43. Graham JM, Blanco JD, Oshiro BT, Magee KP. Gentamicin levels in pregnant women with pyelonephritis. Am J Perinatol. 1994;11(1):40–1. https://doi.org/10.1055/s-2007-994533.

    Article  CAS  Google Scholar 

  44. Wing DA, Hendershott CM, Debuque L, Millar LK. A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy. Obstet Gynecol. 1998;92(2):249–53. https://doi.org/10.1016/s0029-7844(98)00156-2.

    Article  CAS  Google Scholar 

  45. Sandberg T, Brorson JE. Efficacy of long-term antimicrobial prophylaxis after acute pyelonephritis in pregnancy. Scand J Infect Dis. 1991;23(2):221. https://doi.org/10.3109/00365549109023404.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Maternal and Child Health, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil

    Carlos Augusto Faria

  2. Department of Internal Medicine, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil

    José Carlos Carraro-Eduardo

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  1. Carlos Augusto Faria
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  2. José Carlos Carraro-Eduardo
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Editors and Affiliations

  1. Maternal and Child Department, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil

    Renato Augusto Moreira de Sá

  2. Federal University of Paraíba, João Pessoa, Paraíba, Brazil

    Eduardo Borges da Fonseca

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Faria, C.A., Carraro-Eduardo, J.C. (2022). Urinary Tract Infections. In: Moreira de Sá, R.A., Fonseca, E.B.d. (eds) Perinatology. Springer, Cham. https://doi.org/10.1007/978-3-030-83434-0_43

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  • DOI: https://doi.org/10.1007/978-3-030-83434-0_43

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