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| Year : 2010 | Volume
: 21
| Issue : 2 | Page : 342-344 |
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| Urinary tract infection in pregnancy |
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Abdelaali Bahadi1, Driss El Kabbaj1, Hicham Elfazazi2, Rachid Abbi3, Moulay Rachid Hafidi2, Moulay Mehdi Hassani2, Rahali Moussaoui2, Mohammed Elouennass3, Mohammed Dehayni2, Zouhair Oualim1
1 Service of Nephrology, Hemodialysis and Kidney Transplantation, Military Hospital of Instruction, Mohammed V. Rabat, Morocco
2 Gynecology and Obstetrics, Military Hospital of Instruction, Mohammed V. Rabat, Morocco
3 Microbiology, Military Hospital of Instruction, Mohammed V. Rabat, Morocco
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| Date of Web Publication | 9-Mar-2010 |
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How to cite this article:
Bahadi A, El Kabbaj D, Elfazazi H, Abbi R, Hafidi MR, Hassani MM, Moussaoui R, Elouennass M, Dehayni M, Oualim Z. Urinary tract infection in pregnancy. Saudi J Kidney Dis Transpl 2010;21:342-4 |
How to cite this URL:
Bahadi A, El Kabbaj D, Elfazazi H, Abbi R, Hafidi MR, Hassani MM, Moussaoui R, Elouennass M, Dehayni M, Oualim Z. Urinary tract infection in pregnancy. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2022 Aug 9];21:342-4. Available from: https://www.sjkdt.org/text.asp?2010/21/2/342/60208 |
To the Editor,
Urinary tract infection (UTI) is a common complication of pregnancy. Symptomatic UTI occurs in one to two percent of all pregnancies, while asymptomatic bacteriuria has been reported in 2 to 13% of all pregnant women. [1] Several anatomical and hormonal changes in pregnant women lead to ureteral dilatation and urinary stasis, which contribute to the increased risk of developing UTI. [2] . Untreated UTIs can lead to complications, such as pyelonephritis, low-birth-weight infants, premature delivery, and occasionally, still birth. [3] Therefore, prompt treatment of symptomatic UTI and asymptomatic bacteriuria is required in pregnant women.
We conducted a retrospective study in the service of gynecology and obstetrics of the Military Hospital of Instruction, Mohammed V. Rabat, Morocco. The study was conducted over a period of 18 months from June 2006 to December 2007. We included all pregnant women who underwent cytobacteriologic examination of the urine in the hospital.
During the study period, microscopic urinary examination (MUE) was performed on 147 patients. Overall, 45 study patients had features of UTI. There were 19 patients with acute pyelonephritis (28.9%), 58 patients had uncontrolled diabetes mellitus of whom, 13 had UTI and five other patients had risk of premature birth. The presentation of UTI among the study patients included the following:
- bacteriuria: 23 cases (51.1%) with UTI and 15.6% of all studied cases
- leukocyturia: 22 cases (48.9%) with UTI and 14.96% of all studied cases
In the cases with UTI, the organism grown was Gram negative in all with Eschirichia Coli being the commonest, seen in 14 of 23 patients (60.8%). The sensitivity pattern revealed the following [Figure 1]:
- Amoxicillin: 26/45 cases (57.78%)
- Amoxicillin/Clauvulinic acid: 31/45 cases (68.89%)
- Third generation cephalosporins: 43/45 cases (95.56%)
- Amoxicillin + gentamicin: 43/45 cases (95.56%)
Several factors predispose pregnant females to developing UTI. They include the following: [4]
- Mechanical factors such as compression and stretching of the ureters by the uterus.
- Hormonal factors which cause inhibition of peristalsis of the urinary tract, reduction of the uretero-bladder sphincter tone and promoting the adhesion of germs to the urothelium
- Chemical factors such as alkalinization of urine and physiological glycosuria
- Others: increase in bacteria in the vulvo perineal region during pregnancy
The main clinical presentations include the following:
Asymptomatic bacteriuria: This is the most common form found in 5 to 10% of pregnant wo-men and leads to pyelonephritis in about 10% of affected patients; hence the importance of screening.
Symptomatic UTI: This is represented by acute cystitis and acute pyelonephritis (APN); both can result in complications such as the threat of premature birth and uncontrolled diabetes. According to a literature review, [5],[6],[7],[8] E. Coli is isolated in more than 80% of patients with bacteriuria and 95% of those with APN.
The bacterial culture study shows that over 42% of all organisms grown were resistant to amoxycillin. However, in more than 95% of the cases, the organism was sensitive to third generation cephalosporin and gentamycin. Based on these results, we recommend the treatment of UTI in pregnant women with third generation cephalosporins.
The prevention of UTI in pregnancy aims at preventing colonization of urine through measures such as proper hygiene, prevention of constipation, good toilet training, abundant fluid intake, frequent urination and routine post-coital urination. [9],[10],[11],[12],[13] Screening for bacteriuria is re commended among all pregnant women at the first prenatal visit and in the last trimester of pregnancy. [14],[15] The most effective method is urinalysis followed by culture. In the presence of risk factors for UTI (previous history of UTI, pre-existing renal disease, diabetes), it is recommended to do urinalysis every month. [16],[17],[18],[19]
In conclusion, UTI needs to be detected and treated promptly because treatment has shown its effectiveness in preventing pregnancy related complications. Routine screening for asymptomatic bacteriuria should be practiced regularly. E. coli is the commonest organism causing UTI in pregnancy. Monitoring the sensitivity to antibiotics remains paramount and based on our experience, the use of a third generation cephalosporin is recommended.
 References | |  |
| 1. | Dwyer PL, O′Reilly M. Recurrent urinary tract infection in the female. Curr Opin Obstet Gynecol 2002;14(5):537-43.  |
| 2. | Le J, Briggs GG, McKeown A, Bustillo G. Urinary tract infections during pregnancy. Ann Pharmacother 2004;38(10):1692-701. |
| 3. | Christensen B. Which antibiotics are appro-priate for treating bacteriuria in pregnancy? J Antimicrob Chemother 2000;46(Suppl 1):29-34. [PUBMED] |
| 4. | Module design at birth : urinary tract infection in pregnant women. Faculty of Medicine Starsbourg 2005. |
| 5. | De Mouy.D ,Fabre. R UTI community of women 15 to 65: sensitivity to antibiotics of E. coli according to history: study AFORCOPI-BIO 2003 Medicine and Infectious Diseases 2007;37:594-8. |
| 6. | Lee M, Bozzo P, Einarson A, Koren G . Urinary tract infections in pregnancy. Canadian Fam Physician 2008;54: 853-4 |
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| 8. | Larabi K, Masmoudi A, Fendri C. Bacterio-logical and susceptibility study of 1,930 strains isolated from UTIs in a Tunis university hos-pital. Med Infect Dis 2003;33:348-52. |
| 9. | Alarcon A, Pena P, Salas S, Sancha M, Omenaca F. Neonatal early onset Escherichia coli sepsis: Trends in incidence and antimicrobial resis-tance in the era of intrapartum antimicrobial prophylaxis. Pediatr Infect Dis J 2004;23(4): 295-9. |
| 10. | Berrebi A, Assouline C, Rolland M. Common materna-fetal infectious diseases. Editions Doin 200l;245-86. |
| 11. | Denis F. Bacteria, fungi and parasites transmitted from mother to child. Pathologie Biologie 2002:50:620 |
| 12. | D′Ercole C, Blanc B. Urinary tract infections during pregnancy: Diagnosis, evolution, prog-nosis, treatment. Rev Prat 1994;44(8):1097-103. |
| 13. | Gilstrap LC 3rd, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am 2001;28(3):581-91. |
| 14. | Hill JB, Sheffield JS, McIntire DD, Wendel GD. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005;105(1):18-23. |
| 15. | Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 2003;17(2):367-94. |
| 16. | OMS. Direction de Sante et Recherche gene-siques: Prise en charge des complications de la grossesse et de l′accouchement. Guide destine a la sage femme et au medecin. Fievre pendant la grossesse ou le travail. http://www.who.int/reproductive-health/mcpc_fr/symptome-s/s113_122_fievre_pendant.html |
| 17. | Ovalle A, Levancini M. Urinary tract infections in pregnancy. Curr Opin Urol 2001;11 (1):55-9. |
| 18. | Vazquez JC, Villar J. Treatments for symptom-matic urinary tract infections during preg-nancy. Cochrane Database Syst Rev 2003;4: CD002256. [PUBMED] |
| 19. | Saurela N, Paveseb P, Boyera L, et al. Com-pliance requirements antibiotiquesdans urinary tract infections in adults in hospital. Medecine et Maladies Infectieuses 2006;36:369-74. |
Correspondence Address:
Abdelaali Bahadi
Service of Nephrology, Hemodialysis and Kidney Transplantation, Military Hospital of Instruction, Mohammed V. Rabat
Morocco
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 20228527 
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