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Urinary Tract Infection

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Study Guide for Urinary Tract Infection in Pregnant Women PATHOPHISIOLOGY
1. Bacteriuria occurs commonly in pregnancy, typically during early pregnancy. Without treatment, as many as 30 to 40 percent of pregnant women with asymptomatic bacteriuria will develop a symptomatic urinary tract infection (UTI). Other organisms responsible for infection included Klebsiella and Enterobacter species (3 percent each), Proteus (2 percent), and gram-positive organisms, including group B Streptococcus (10 percent).The smooth muscle relaxation and subsequent ureteral dilatation that occurs in pregnancy are thought to facilitate the ascent of bacteria from the bladder to the kidney, accounting for the greater risk of pyelonephritis. Additionally, untreated …show more content…

●As in nonpregnant women, Escherichia coli is the predominant uropathogen found in both asymptomatic bacteriuria and UTI in pregnant women.
3. ●Screening should be done for all pregnant women at least once for asymptomatic bacteriuria. Screening for asymptomatic bacteriuria is performed at 12 to 16 weeks gestation with a midstream urine for culture. The diagnosis is made by finding high-level bacterial growth (≥105 colony forming units [cfu]/mL) on urine culture in the absence of symptoms consistent with UTI.
4. ●Acute cystitis should be suspected in pregnant women who complain about new onset dysuria, frequency, or urgency. The diagnosis is made by finding of bacterial growth on urine culture in this …show more content…

Acute pyelonephritis during pregnancy is suggested by the presence of flank pain, nausea/vomiting, fever (>38ºC), and/or costovertebral angle tenderness, with or without the typical symptoms of cystitis, and is confirmed by the finding of bacteriuria in the setting of these symptoms. Pregnant women may become quite ill and are at risk for both medical (eg, sepsis, respiratory failure) and obstetrical complications from pyelonephritis
MEDS
6. ●Management of asymptomatic bacteriuria in pregnant women includes antibiotic therapy tailored to culture results, which reduces the risk of subsequent pyelonephritis and is associated with improved pregnancy outcomes. Potential options include beta-lactams, nitrofurantoin, and fosfomycin . Following treatment, follow-up cultures are performed to confirm sterilization of the urine. For those women with persistent bacteriuria, prophylactic or suppressive antibiotics may be warranted in addition to retreatment.
7. Management of acute cystitis in pregnant women includes empiric antibiotic therapy that is subsequently tailored to culture results. Potential options for empiric and directed therapy include beta-lactams, nitrofurantoin, and fosfomycin . As with asymptomatic bacteriuria, follow-up cultures are performed to confirm sterilization of the urine. For those women with persistent bacteriuria or recurrent cystitis, prophylactic or suppressive antibiotics may be warranted in addition to

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