From the Guidelines
Yes, Staphylococcus saprophyticus should be treated in the urine of pregnant patients. The recommended treatment is typically based on the guidelines for asymptomatic bacteriuria (ASB) in pregnant women, which suggest screening for and treating ASB, including S. saprophyticus, to prevent potential complications such as pyelonephritis, preterm labor, and low birth weight 1. According to the 2019 update by the Infectious Diseases Society of America, in pregnant women with ASB, including those with S. saprophyticus, 4–7 days of antimicrobial treatment is suggested rather than a shorter duration 1.
Some key points to consider in the treatment of S. saprophyticus in pregnant patients include:
- The choice of antibiotic should be based on susceptibility patterns and safety in pregnancy
- Nitrofurantoin and cephalexin are commonly used options, but the specific choice and duration should be guided by local resistance patterns and patient-specific factors
- Follow-up urine culture after treatment completion is recommended to ensure resolution of the infection
- Preventive measures such as adequate hydration and urinating after intercourse may help prevent recurrence
It's essential to note that while the evidence specifically addressing S. saprophyticus in pregnancy may be limited, the general principles of treating ASB in pregnancy apply, and treatment is necessary to prevent potential complications 1. The guidelines suggest a urine culture collected at one of the initial visits early in pregnancy, and there is insufficient evidence to inform a recommendation for or against repeat screening during the pregnancy for a woman with an initial negative screening culture or following treatment of an initial episode of ASB 1.
From the Research
Treatment of Staphylococcus Saprophyticus in Pregnant Patients
- Staphylococcus saprophyticus is a frequent cause of urinary tract infections in women, including pregnant women 2.
- The study found that 83.9% of S. saprophyticus strains were isolated from women aged 15 to 44 years, and 37 women in this group were pregnant 2.
- The American College of Obstetricians and Gynecologists recommends screening for and treating asymptomatic bacteriuria in pregnant women to prevent complications such as pyelonephritis and preterm labor 3.
- Staphylococcus saprophyticus is resistant to many commonly used antibiotics, including penicillin, amoxicillin, and ceftriaxone 2, 4.
- However, S. saprophyticus is susceptible to vancomycin, rifampin, gentamicin, and amoxicillin-clavulanic acid 2.
- Fluoroquinolones, such as ciprofloxacin, may also be effective in treating S. saprophyticus infections, but their use in pregnancy is limited due to potential risks to the fetus 5.
Antibiotic Resistance and Treatment Options
- The study found that 55.6% of S. saprophyticus strains were resistant to penicillin, and 45% were considered oxacillin-resistant 2.
- Ceftriaxone had high minimum inhibitory concentrations (MICs) for S. saprophyticus, making it a less effective treatment option 4.
- Amoxicillin-clavulanic acid may be a suitable alternative for treating S. saprophyticus infections, but its effectiveness depends on the susceptibility of the strain 2, 4.
- Pregnant women with S. saprophyticus infections should be treated with antibiotics that are safe for use during pregnancy and effective against the infecting strain 2, 3.