From the Guidelines
Pregnant patients with suspected urinary tract infections (UTIs) should undergo a thorough workup, including a urine culture, to guide appropriate antimicrobial therapy.
Workup for Pregnant Patients with Suspected UTI
- A urine culture is essential to confirm the diagnosis and identify the causative organism, as the microbial spectrum is greater in complicated UTIs, and antimicrobial resistance is more likely 1.
- Symptomatic evaluation is crucial, as pregnant women with asymptomatic bacteriuria are at increased risk of developing pyelonephritis and low birthweight 1.
- Risk factor assessment should be performed to identify potential complicating factors, such as obstruction, diabetes, or immunosuppression, which may affect treatment outcomes 1.
- Imaging studies may be indicated in certain cases, such as recurrent UTIs or suspected complications, to detect underlying abnormalities or monitor disease progression 1.
- Antimicrobial therapy should be tailored to the specific uropathogen isolated and local resistance patterns, with treatment duration ranging from 7 to 14 days, depending on the severity of the illness and underlying complicating factors 1.
Key Considerations
- Pregnancy is considered a complicating factor for UTIs, and therefore, a more thorough workup and tailored treatment approach are necessary 1.
- Antibiotic resistance is a concern in complicated UTIs, and empiric therapy should be guided by local resistance patterns and susceptibility testing 1.
- Urine culture and susceptibility testing are essential to ensure appropriate antimicrobial therapy and minimize the risk of antibiotic resistance 1.
From the Research
Diagnostic Approach
The workup for a pregnant patient with a suspected urinary tract infection (UTI) involves a combination of clinical evaluation, laboratory tests, and imaging studies. The diagnostic approach includes:
- Clinical evaluation: assessing symptoms such as change in frequency, dysuria, urgency, and presence or absence of vaginal discharge 2
- Laboratory tests:
- Dipstick urinalysis: popular for its availability and usefulness, but results must be interpreted in context of the patient's pretest probability based on symptoms and characteristics 2
- Microscopic urinalysis: comparable to dipstick urinalysis as a screening test 2
- Urine culture: the gold standard for detection of UTI, particularly in cases where the probability of UTI is moderate or unclear 2, 3
- Imaging studies: may be necessary in certain cases, such as suspected pyelonephritis or complications 4
Interpretation of Test Results
The interpretation of test results is crucial in diagnosing UTI in pregnant women. Key points to consider:
- Positive dipstick testing is likely specific for asymptomatic bacteriuria in pregnancy, but urine culture is still the test of choice 2
- Bacteriuria is more specific and sensitive than pyuria for detecting UTI, even in older women and during pregnancy 2
- Resistance to commonly used antibiotics is increasing, and empirical treatment should be minimized 5
Treatment Approach
The treatment approach for UTI in pregnant women involves:
- Antibacterial therapy (ABT): the basis for treatment, with rational selection of a specific drug depending on the severity of the UTI 6
- Oral ABT for uncomplicated UTI: includes nitrofurans, fosfomycin trometamol, and third-generation cephalosporins, such as cefixime 6
- Parenteral forms: preferred in cases of complicated UTI requiring hospitalization 6
- Consideration of antibiotic resistance patterns: essential in selecting the most effective treatment 5, 3