A urinary tract infection (UTI ) is an infection in any part of urinary system, which includes urethera , urinary bladder ureters, and kidneys. Ecoli are responsible for 70-80% percent of the cases other bacteria include are Klebsiella pneumoniae ,proteus mirabilis ,Enterobacter species ,staphylococcus saprophyticus, Group B beta-hemolytic streptococci and Proteus species.
Changes in hormones can lead to vesicoureteral reflux and subsequently UTI.
Growing uterus presses on bladder which leads to stasis of urine in bladder and causes infection. Left over urine can be a source of infection.
Escherichia coli and other bacteria move from anus to urethra if wiping from back to front while washing or during sexual intercourse.
The symptoms of a UTI can include:
A burning feeling while passing urine
A frequent or intense urge to pass urine
Cloudy, dark, bloody, or strange-smelling urine
Feeling tired or shaky
Fever or chills (pyelonephritis)
Pain or pressure in back or lower abdomen
Nausea and vomiting
INVESTIGATION OF UTIs:
General urine examination, testing for acetone nitrites and ketones and Urine culture .If suspected pyelonephritis then add Complete blood count, C reactive protein ,blood culture, Renal function test ,Liver function test ,blood cultures and Ultrasound of abdomen Selected cases of recurrent UTIs will require, cystoscopy
UTI Complications During Pregnancy :0.5 – 2%
Occur in second or third trimester
Pyelonephritis affects kidneys, and can complicate to Adult respiratory syndrome and septicemia
Fetal complications are preterm birth and low birth weight fetus
UTI Treatment During Pregnancy
Many common antibiotics broad spectrum antibiotics are used Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5-7 days or
Amoxicillin 875 mg orally twice daily (alternative: 500 mg orally three times daily) for 5-7 days or Amoxicillin-clavulanate 500/125 mg orally three times daily for 5-7 days (alternative: 875/125 mg orally two times daily for 5-7 days) Cephalexin 500 mg orally four times daily for 5-7 days .
Urine culture should show negative findings 1-2 weeks after completion of therapy.
Hydration to flush the bacteria from the body.
Analgesics for pain.
In pyelonephritis admission intravenous hydration, intravenous antibiotics and change of antibiotics if indicted according to urine culture report.
Multi disciplinary team involvement including obstetrician, physician, microbiologist, anesthetist in cases with severe complications of UTI develop.
PREVENTION
Empty the bladder often as soon as there is urge.
Empty bladder completely.
Wipe from front to back after using the toilet.
Drink plenty of water.
Choose showers over baths.
Avoid feminine hygiene sprays, scented douches, and scented bath products.
Cleanse genital area before sex and pass urine after sex to flush out any bacteria
Keep genital area dry, use cotton underwear and loose-fitting clothes. Avoid tight jeans and
nylon undergarment
Asymptomatic Bacteriuria
Presence of more than 100,000 organism/mL in 2 consecutive urine samples in the absence of symptoms.
If bacteriuria is untreated 30% will develop pyelonephritis ,which can lead to Adult respiratory syndrome and Sepsis.
Asymptomatic bacteriuria occurs in 2 to 7 percent of pregnant women in early pregnancy, quarter of the cases identified in the second and third trimesters.
Recurrent bacteriuria is more common during pregnancy.
Pyelonephritis can lead to low birth weight and preterm labour. This risk is reduced by 70 to 80 percent if bacteriuria is eradicated.
Group B streptococcus (GBS)
Many women have this bacteria in their colon and vagina which can cause UTIs and women can pass it to their new born during labour causing GBS infection in neonates.
Many countries do GBS screening at 36 to 37 weeks by checking urine and vaginal swab.
If positive for GBS, Intravenous antibiotics during labor are recommended.
GBS UTI should be treated during antenatal period and subsequently GBS prophylaxis is given in labour.
GBS colonization in vagina is not treated in antenatal period, instead women are given antibiotic prophylaxis in labour.
Recurrent Cystitis
Pregnant women who have three or more episodes of cystitis or bacteriuria should be started on daily antibiotic prophylaxis for the remainder of pregnancy. Daily antibiotics should also be considered in pregnant women after one episode of pyelonephritis. Regimens for daily prophylaxis includes nitrofurantion 100 mg nightly, or cephalexin 250-500 mg nightly.
Patients who are immunosuppressed or have medical conditions which increase the risk of
of complications from cystitis, consider antibiotic prophylaxis after one episode of cystitis.
Surgical Treatment
Surgery is rarely indicted, and is usually planned in second trimester to avoid risk to fetus in first trimester and preterm labour in third trimester.
Cystoscopy is indicated for the diagnosis of urethral or bladder diverticulum, bladder stones, urethral syndrome, lower urinary tract trauma, interstitial cystitis, or bladder cancer.
A retrograde stent or a percutaneous nephrostomy tube to relieve ureteral colic or decompress an obstructed infected collecting system.
Ureteroscopic stone extraction, are rarely indicated.
Extracorporeal shock wave lithotripsy (ESWL) is contraindicated in pregnancy.
Article by Dr.Tasleem Quddus, Gynaecologist, Babylon Medical Services LLC.