Do I need to treat a pregnant person with a positive Klebsiella pneumoniae (K. pneumoniae) urine culture?

From the Guidelines

Yes, you should treat a pregnant person with a positive Klebsiella pneumoniae urine culture, even if they are asymptomatic. The Infectious Diseases Society of America guidelines recommend screening for and treating bacteriuria in pregnant women, as asymptomatic bacteriuria can progress to pyelonephritis, which poses significant risks to the mother and fetus, including preterm labor and low birth weight 1.

Key Considerations

• The guidelines define bacteriuria as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts ≥10^5 cfu/mL for asymptomatic women 1.
• A single catheterized urine specimen with 1 bacterial species isolated in a quantitative count ≥10^2 cfu/mL also identifies bacteriuria in women 1.
• Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment, but the presence of bacteriuria itself, such as with K. pneumoniae, necessitates treatment in pregnant women 1.

Treatment Recommendations

• The recommended duration of antimicrobial therapy is 3–7 days 1.
• Appropriate antibiotic choices may include oral antibiotics such as cephalexin or amoxicillin-clavulanate, with considerations for potential allergies or resistance patterns.
• Follow-up urine culture after treatment is essential to confirm clearance of the infection.

Rationale for Treatment

• Pregnancy increases the risk of asymptomatic bacteriuria progressing to more severe infections due to physiological changes like urinary stasis and altered immune response.
• K. pneumoniae, being a gram-negative bacterium, can be particularly virulent, underscoring the need for prompt and effective treatment in pregnant individuals to prevent complications.

From the FDA Drug Label

Genitourinary tract infections, including acute prostatitis, caused by Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae

Yes, you should treat a pregnant person with a positive Klebsiella pneumoniae urine culture, as Klebsiella pneumoniae is a susceptible organism for urinary tract infections, according to the drug labels of cephalexin 2 and ceftriaxone 3. However, it's essential to consider the potential risks and benefits of treatment, as well as the patient's individual circumstances, and consult the drug label for fosfomycin 4 for additional guidance on treating urinary tract infections during pregnancy.

From the Research

Treatment of Klebsiella pneumoniae Urinary Tract Infection in Pregnant Women

• The treatment of Klebsiella pneumoniae urinary tract infection (UTI) in pregnant women is crucial to prevent complications such as pyelonephritis, preterm labor, and low birth weight 5, 6, 7.
• Studies have shown that Klebsiella pneumoniae is a common cause of UTIs in pregnant women, with a prevalence of 37.41% in one study 5 and 36.9% in another study 6.
• The choice of antibiotic for treatment is important, as Klebsiella pneumoniae has shown high resistance to commonly used antibiotics such as ampicillin, amoxicillin, and ceftazidime/clavulanic acid 5, 6.
• Fosfomycin has been suggested as a first-line treatment regimen due to its high sensitivity and safety for use in pregnancy 8.
• Other antibiotics such as ciprofloxacin, ceftriaxone, and nitrofurantoin may also be effective, but their use should be guided by antimicrobial susceptibility testing 5, 6, 8.
• It is essential to note that the treatment of UTIs in pregnant women should be individualized, taking into account the specific bacterial isolate, antimicrobial susceptibility, and the trimester of pregnancy 7, 8.

Antimicrobial Resistance and Treatment

• Antimicrobial resistance is a significant concern in the treatment of UTIs in pregnant women, with studies showing high resistance rates to commonly used antibiotics 5, 6.
• The use of broad-spectrum antibiotics should be minimized to reduce the risk of antimicrobial resistance and promote antibiotic stewardship 7.
• Regular screening for UTIs and antimicrobial susceptibility testing can help guide treatment and reduce the risk of complications 5, 6, 8.

Clinical Implications

• Pregnant women with a positive Klebsiella pneumoniae urine culture should be treated promptly to prevent complications 5, 6, 7.
• The choice of antibiotic should be guided by antimicrobial susceptibility testing and the trimester of pregnancy 7, 8.
• Fosfomycin may be a suitable first-line treatment option due to its high sensitivity and safety for use in pregnancy 8.