From the Guidelines
Pregnant women with bacteriuria should be treated with antimicrobials to decrease the risk of pyelonephritis and potentially reduce the risk of low birth weight and preterm labor.
Treatment Details
- The duration of antimicrobial therapy should be 3–7 days 1.
- Nitrofurantoin is a commonly used antimicrobial for the treatment of asymptomatic bacteriuria in pregnancy 1.
- Screening for bacteriuria should be done by urine culture at least once in early pregnancy, and pregnant women should be treated if the results are positive 1.
Rationale
- Asymptomatic bacteriuria occurs in 2%–7% of pregnant women and increases the risk of pyelonephritis, low birth weight, and preterm labor 1.
- Antimicrobial treatment of asymptomatic bacteriuria during pregnancy decreases the risk of subsequent pyelonephritis from 20%–35% to 1%–4% 1.
- The benefits of screening and treatment of asymptomatic bacteriuria in pregnant women have been consistently reported in multiple studies, resulting in it becoming a standard of care in developed countries 1.
From the Research
Treatment for Bacteriuria in Pregnancy
The treatment for bacteriuria (presence of bacteria in the urine) in pregnancy is primarily focused on preventing complications such as pyelonephritis, preterm birth, and low birth weight.
- Treatment of any bacteriuria with colony counts ≥ 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics 2.
- Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the time of labour or rupture of membranes with appropriate intravenous antibiotics for the prevention of early-onset neonatal group B streptococcal disease 2.
- Asymptomatic women with urinary group B streptococcal colony counts < 100 000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth 2.
- Treatment of asymptomatic bacteriuria in pregnant women has been shown to decrease the risk of symptomatic UTI, low birthweight, and preterm delivery 3, 4, 5, 6.
Screening and Treatment
- The US Preventive Services Task Force recommends screening pregnant persons for asymptomatic bacteriuria using urine culture 5.
- Screening and treatment for asymptomatic bacteriuria during pregnancy was associated with reduced rates of pyelonephritis and low birth weights 6.
- The benefits of asymptomatic bacteriuria treatment in nonpregnant adult populations were not found 3, 5, 6.
Key Findings
- Pyelonephritis in pregnancy is associated with negative maternal outcomes and that treatment of screen-detected asymptomatic bacteriuria can reduce the incidence of pyelonephritis in pregnant persons 5.
- There is adequate evidence that pyelonephritis in pregnancy is associated with perinatal complications including septicemia, respiratory distress, low birth weight, and spontaneous preterm birth 5.