Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2010  |  Volume : 21  |  Issue : 2  |  Page : 342--344

Urinary tract infection in pregnancy


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

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




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;21:342-344


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 Jan 27 ];21:342-344
Available from: https://www.sjkdt.org/text.asp?2010/21/2/342/60208


Full Text

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 casesleukocyturia: 22 cases (48.9%) with UTI and 14.96% of all studied casesIn 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 urotheliumChemical factors such as alkalinization of urine and physiological glycosuriaOthers: increase in bacteria in the vulvo­ perineal region during pregnancyThe 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.

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