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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 342-344
Urinary tract infection in pregnancy


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 Publication9-Mar-2010
 

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 2020 Jul 12];21:342-4. Available from: http://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:

  1. bacteriuria: 23 cases (51.1%) with UTI and 15.6% of all studied cases
  2. 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]

  1. Mechanical factors such as compression and stretching of the ureters by the uterus.
  2. 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
  3. Chemical factors such as alkalinization of urine and physiological glycosuria
  4. 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 Top

1.Dwyer PL, O′Reilly M. Recurrent urinary tract infection in the female. Curr Opin Obstet Gynecol 2002;14(5):537-43.  Back to cited text no. 1      
2.Le J, Briggs GG, McKeown A, Bustillo G. Urinary tract infections during pregnancy. Ann Pharmacother 2004;38(10):1692-701.  Back to cited text no. 2      
3.Christensen B. Which antibiotics are appro-priate for treating bacteriuria in pregnancy? J Antimicrob Chemother 2000;46(Suppl 1):29-34.  Back to cited text no. 3  [PUBMED]    
4.Module design at birth : urinary tract infection in pregnant women. Faculty of Medicine Starsbourg 2005.  Back to cited text no. 4      
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.  Back to cited text no. 5      
6.Lee M, Bozzo P, Einarson A, Koren G . Urinary tract infections in pregnancy. Canadian Fam Physician 2008;54: 853-4  Back to cited text no. 6      
7.MacLean AB. Urinary tract infection in preg-nancy. Int J Antimicrob Agents 2001;17:273-7.  Back to cited text no. 7  [PUBMED]    
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.  Back to cited text no. 8      
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.  Back to cited text no. 9      
10.Berrebi A, Assouline C, Rolland M. Common materna-fetal infectious diseases. Editions Doin 200l;245-86.  Back to cited text no. 10      
11.Denis F. Bacteria, fungi and parasites transmitted from mother to child. Pathologie Biologie 2002:50:620  Back to cited text no. 11      
12.D′Ercole C, Blanc B. Urinary tract infections during pregnancy: Diagnosis, evolution, prog-nosis, treatment. Rev Prat 1994;44(8):1097-103.  Back to cited text no. 12      
13.Gilstrap LC 3rd, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am 2001;28(3):581-91.  Back to cited text no. 13      
14.Hill JB, Sheffield JS, McIntire DD, Wendel GD. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005;105(1):18-23.  Back to cited text no. 14      
15.Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 2003;17(2):367-94.  Back to cited text no. 15      
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   Back to cited text no. 16      
17.Ovalle A, Levancini M. Urinary tract infections in pregnancy. Curr Opin Urol 2001;11 (1):55-9.  Back to cited text no. 17      
18.Vazquez JC, Villar J. Treatments for symptom-matic urinary tract infections during preg-nancy. Cochrane Database Syst Rev 2003;4: CD002256.  Back to cited text no. 18  [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.  Back to cited text no. 19      

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Correspondence Address:
Abdelaali Bahadi
Service of Nephrology, Hemodialysis and Kidney Transplantation, Military Hospital of Instruction, Mohammed V. Rabat
Morocco
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PMID: 20228527

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