From the Guidelines
Yes, a repeat urine culture is necessary after treating a Urinary Tract Infection (UTI) in pregnancy. According to the European Association of Urology guidelines 1, a urine culture is recommended in pregnant women after completion of treatment to confirm eradication of the infection. This is also supported by the Infectious Diseases Society of America guidelines 1, which recommend screening for and treatment of asymptomatic bacteriuria in pregnant women, as well as periodic screening for recurrent bacteriuria after therapy.
- The follow-up culture should be performed 1-2 weeks after completion of antibiotic therapy, typically with nitrofurantoin 100mg orally twice daily for 5-7 days or cephalexin 500mg orally three times daily for 5-7 days 1.
- A negative urine culture result after treatment indicates successful resolution of the UTI, while a positive result may require further evaluation and potential adjustment of antibiotic therapy 1.
- The purpose of the repeat urine culture is to confirm eradication of the infection and rule out persistent or recurrent bacteriuria, which can increase the risk of pyelonephritis and other complications in pregnancy 1.
From the Research
Urinary Tract Infections in Pregnancy
- Urinary tract infections (UTIs) are a common complication during pregnancy, affecting approximately 2% to 15% of women 2.
- The presence of UTIs has been associated with adverse pregnancy outcomes, including increased rates of preterm delivery and low birth weight 2, 3.
Diagnosis and Treatment
- Screening for and treating asymptomatic bacteriuria have been shown to reduce the incidence of pyelonephritis in pregnancy 2, 3.
- A single urine culture in the first trimester is recommended for screening asymptomatic bacteriuria 2.
- Antibiotics such as β-lactams, nitrofurantoin, or fosfomycin are recommended for treatment 2.
Repeat Urine Culture
- There is limited evidence on the necessity of a repeat urine culture after treating a UTI in pregnancy 2, 4, 5, 3, 6.
- However, urine culture is recommended for the diagnosis and management of pyelonephritis, recurrent urinary tract infection, and complicated urinary tract infections 6.
Management of UTIs in Pregnancy
- Early diagnosis and management of UTIs can lead to fewer complications 5.
- Preferred antimicrobials for the management of pyelonephritis include amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems 2.
- Further research is required to understand the true incidence of ASB-related complications and the benefit and modalities of screening for ASB and to further explore prophylactic measures 2.