Urinary tract infections in pregnant women: prevention and treatment
Urinary tract infections (UTIs) are a common infectious disease during pregnancy, while the range of effective and safe medications for the mother and fetus is limited.Bakhareva I.V.
Objective. To assess current concepts on the etiology, pathogenesis, clinical presentations, diagnosis, and treatment of UTIs in pregnant women.
Material and methods. Publications by Russian and foreign authors were reviewed and analyzed.
Results. Particular attention is paid to the classification of UTIs, to their predisposing factors, etiology, pathogenesis, and diagnosis during pregnancyy, to the impact of UTIs on the development of pregnancy complications and fetal diseases, and to antimicrobial therapy policy. Emphasis is laid on the need for the prevention and combination treatment of asymptomatic bacteriuria in pregnant women and there is evidence that the large cranberry (Vaccinium macrocarpon) drug phytolysin prenatal should be used to prevent recurrent UTIs during pregnancy.
Conclusion. The timely diagnosis and rational therapy of UTIs in pregnant women can reduce the risk of recurrences and pregnancy complications.
Keywords
urinary tract infections
pregnancy
asymptomatic bacteriuria
pyelonephritis
large cranberry (Vaccinium macrocarpon) drugs
phytolysin prenatal
Supplementary Materials
References
1. Szweda H., Jóźwik M. Urinary tract infections during pregnancy – an updated overview. Dev. Period. Med. 2016; 20(4): 263-72.
2. Пустотина О.А. Бессимптомная бактериурия у беременных: о чём говорит доказательная медицина. Медицинский совет. 2016; 4: 123-9. [Pustotina O.A. Asymptomatic bacteriuria in pregnant women: as evidenced by evidence-based medicine. Meditsinskiy sovet. 2016; 4: 123-9. (in Russian)]
3. Архипов Е.В., Сигитова О.Н. Инфекции мочевых путей у беременных: современные рекомендации по диагностике и лечению. Вестник современной клинической медицины. 2016; 9(6): 109-14. [Arkhipov E.V., Sigitova O.N. Urinary tract infections in pregnant women: modern recommendations for diagnosis and treatment. Vestnik sovremennoy klinicheskoy meditsiny. 2016; 9(6): 109-14. (in Russian)]
4. Souza R.B., Trevisol D.J., Schuelter-Trevisol F. Bacterial sensitivity to fosfomycin in pregnant women with urinary infection. Braz. J. Infect. Dis. 2015; 19(3):319-23.
5. Каптильный В.А. Инфекция мочевыводящих путей во время беременности. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2015; 2(4): 10-9. [Kaptilny V.P. Urinary tract infection during pregnancy. V.F. Snegirev Archive of Obstetrics and Gynecology. 2015; 2(4): 10-9. (in Russian)]
6. Glaser A.P., Schaeffer A.J. Urinary tract infection and bacteriuria in pregnancy. Urol. Clin. North Am. 2015; 42(4): 547-60.
7. Наумкина Е.В., Абросимова О.А., Иванова С.Ф. Бессимптомная бактериурия и состояние микробиоценоза половых путей у беременных. Инфекция и иммунитет. 2016; 6(3): 77. [Naumkina E.V., Abrosimova O.A., Ivanova S.F. Asymptomatic bacteriuria and the state of the microbiocenosis of the genital tract in pregnant women. Infektsiya i immunitet. 2016; 6(3): 77. (in Russian)]
8. Thomas A.A., Thomas A.Z., Campbell S.C., Palmer J.S. Urologic emergencies in pregnancy. Urology. 2010; 76(2): 453-60.
9. Khasriya R., Khan S., Lunawat R., Bishara S., Bignall J., Malone-Lee M. et al. The inadequacy of urinary dipstick and microscopy as surrogate markers of urinary tract infection in urological outpatients with lower urinary tract symptoms without acute frequency and dysuria. J. Urol. 2010; 183(5): 1843-7.
10. Salvatore S., Salvatore S., Cattoni E., Siesto G., Serati M., Sorice P., Torella M. Urinary tract infections in women. Eur. J. Obstet. Gynecol. Reprod. Biol. 2011; 156(2): 131-6.
11. Палагин И.С., Сухоруков А.В., Дехнич А.В., Эйдельштейн М.В., Шевелев А.Н., Гринев А.В., Перепанова Т.С., Козлов Р.С. Современное состояние антибиотикорезистентности возбудителей внебольничных инфекций мочевых путей в России: результаты исследования «ДАРМИС» (2010-2011). Клиническая микробиология и антимикробная химиотерапия. 2012; 14(4): 280-302. [Palagin I.S., Sukhorukov A.V., Dehnich A.V., Eidelshtein M.V., Shevelev A.N., Grinev A.V., Perepanova T.S., Kozlov R.S. The current state of antibiotic resistance of pathogens of community-acquired infections of the urinary tract in Russia: the results of the DARMIS study (2010-2011). Klinicheskaya mikrobiologiya i antimikrobnaya himioterapiya. 2012; 14 (4): 280-302. (in Russian)]
12. Хуснутдинова Т.А., Шипицына Е.В., Савочкина Ю.А., Тимошина О.Ю., Рыбина Е.В., Гущин А.Е., Савичева А.М. Определение значимой бактериурии у беременных женщин методом количественной ПЦР в реальном времени. Журнал акушерства и женских болезней. 2016; 65(4): 50-6. [Khusnutdinova T.A., Shipitsyna E.V., Savochkina Yu.A., Timoshina O.Yu., Rybina E.V., Gushchin A.E., Savicheva A.M. Determination of significant bacteriuria in pregnant women by quantitative real-time PCR. Zhurnal akusherstva i zhenskih bolezney. 2016; 65(4): 50-6. (in Russian)]
13. Кравченко Е.Н., Гордеева И.А. Особенности течения гестации и родов при бессимптомной бактериурии у беременных: практический опыт и лечебные аспекты. Гинекология. 2014; 16(2): 78-81. [Kravchenko E.N., Gordeeva I.A. Features of the course of gestation and labor with asymptomatic bacteriuria in pregnant women: practical experience and medical aspects. Ginekologiya. 2014; 16 (2): 78-81. (in Russian)]
14. Smaill F.M., Vasquez J.C. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst. Rev. 2015; (8): CD000490.
15. Widmer M., Lopez I., Gülmezoglu A.M., Mignini L., Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst. Rev. 2015 ; (11): CD000491.
16. Verani J.R., McGee L., Schrag S.J.; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm. Rep. 2010; 59(RR-10): 1-36.
17. Ледина А.В., Прилепская В.Н. Инфекции мочевыводящих путей у беременных. Новые возможности противорецидивной терапии. Гинекология. 2013; 15(5): 44-7. [Ledina A.V., Prilepskaya V.N. Urinary tract infections in pregnant women. New possibilities of anti-relapse therapy. Ginekologiya. 2013; 15(5): 44-7. (in Russian)]
18. Wing D.A., Rumney P.J., Hindra S., Guzman L., Le J., Nageotte M. Pilot study to evaluate compliance and tolerability of cranberry capsules in pregnancy for the prevention of asymptomatic bacteriuria. J. Altern. Complement. Med. 2015; 21(11): 700-6.
19. Радзинский В.Е., Хапова Т.В., Оленев А.С., Соловьёва А.В. Экстракт клюквы у беременных с инфекциями мочевых путей: вопросы эффективности и безопасности. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2014; 5: 22-3. [Radzinsky V.E., Khapova T.V., Olenev A.S., Solovyova A.V. Cranberry extract in pregnant women with urinary tract infections: issues of efficacy and safety. StatusPraesens. Gynecology, obstetrics, barren marriage. 2014; 5: 22-3. (in Russian)]
20. Сычев Д.А. Применение препаратов клюквы в урологической практике: взгляд клинического фармаколога. Урология. 2011; 6: 97-103. [Sychev D.A. The use of cranberry preparations in urological practice: the view of a clinical pharmacologist. Urologiya. 2011; 6: 97-103. (in Russian)]
21. Wing D.A., Fassett M.J., Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am. J. Obstet. Gynecol. 2014; 210(3): 219. e1-6.
22. Gomi H., Goto Y., Laopaiboon M., Usui R., Mori R. Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Cochrane Database Syst. Rev. 2015; (2): CD009216.
23. Yazdy M.M., Mitchell A.A., Werler M.M. Maternal genitourinary infections and the risk of gastroschisis. Am. J. Epidemiol. 2014; 180(5): 518-25.
24. United States Preventive Services Task Force (USPSTF). Final recommendation statement. Asymptomatic bacteriuria in adults: Screening. July, 2008. Available at: http://www. uspreventiveservicestaskforce.org/Page/Document/ RecommendationStatementFinal/asymptomatic-bacteriuria- in-adults-screening 2016
25. Об утверждении Порядка оказания медицинской помощи по профилю «Акушерство и гинекология (за исключением использования вспомогательных репродуктивных технологий)»: Приказ Министерства здравоохранения РФ, 01 октября 2012 г. №572н.
Гинекология. 2014; 16(2): 78-81. [On the approval of the Order of medical care for the profile of “Obstetrics and Gynecology (with the exception of the use of assisted reproductive technologies)”: Order of the Ministry of Health of the Russian Federation, October 01, 2012, No. 572n. Gynecology. 2014; 16 (2): 78-81. (in Russian)]
26. Food and Drug Administration. Pregnancy, lactation, and reproductive potential: labeling for human prescription drug and biological products – content and format guidance for industry. Available at: http://www.fda.gov/downloads/drugs/ guidancecomplianceregulatoryinformation/guidances/ ucm450636.pdf 2016.
27. Vazquez J.C., Abalos E. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst. Rev. 2011; (1): CD002256.
28. Ortega-González Y., Castro-Diaz D. Antibiotic considerations for urinary tract infections in pregnancy. Current Bladder Dysfunction Reports. 2014; 9(3):167-74.
29. Usta T.A., Dogan O., Ates U., Yucel B., Onar Z., Kaya E. Comparison of single-dose and multiple-dose antibiotics for lower urinary tract infection in pregnancy. Int. J. Gynaecol. Obstet. 2011; 114(3): 229-33.
30. Unlu B.S., Yildiz Y., Keles I., Kaba M., Kara H., Tasin C. et al. Urinary tract infection in pregnant population, which empirical antimicrobial agent should be specified in each of the three trimesters? Ginekol. Pol. 2014; 85(5): 371-6.
31. Goldberg O., Moretti M., Levy A., Koren G. Exposure to nitrofurantoin during early pregnancy and congenital malformations: a systematic review and meta-analysis. J. Obstet. Gynaecol. Can. 2015; 37(2): 150-6.
32. American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 494: Sulfonamides, nitrofurantoin, and risk of birth defects. Obstet. Gynecol. 2011; 117(6): 1484-5.
33. Schneeberger C., Geerlings S.E., Middleton P., Crowther C.A. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst. Rev. 2015; (7): CD009279.
34. Liska D.J., Kern H.J., Maki K.C. Cranberries and urinary tract infections: how can the same evidence lead to conflicting advice? Adv. Nutr. 2016; 7(3): 498-506.
35. Dante G., Pedrielli G., Annessi E., Facchinetti F. Herb remedies during pregnancy: А systematic review of controlled clinical trial. J. Matern. Fetal Neonatal Med. 2013; 26(3): 306-12.
36. Dante G., Bellei G., Neri I., Facchinetti F. Herbal therapies in pregnancy: what works? Curr. Opin. Obstet. Gynecol. 2014; 26(2): 83-91.
37. Jepson R.G., Williams G., Craig J.C. Cranberries for preventing urinary tract infections. Cochrane Database Syst. Rev. 2012; (10): CD001321.
38. Wing D.A., Rumney P.J., Leu S.Y., Zaldivar F. Comparison of urinary cytokines after ingestion of cranberry juice cocktail in pregnant subjects: a pilot study. Am. J. Perinatol. 2010; 27(2): 137-42.
39. Freire G. de C. Cranberries for preventing urinary tract infections. Sao Paulo Med J. 2013; 131(5): 363.
40. Foxman B., Cronenwett A.E., Spino C., Berger M.B., Morgan D.M. Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial Am. J. Obstet. Gynecol. 2015; 213(2): 194. e1-8.
41. Радзинский В.Е., Хапова Т.В., Оленев А.С., Соловьева А.В. Отёки у беременных: заболевание или норма? Гинекология. 2014; 16(3): 72-4. [Radzinsky V.E., Khapova T.V., Olenev A.S., Solovieva A.V. Edema in pregnant women: a disease or a norm? Gynecology. 2014; 16(3): 72-4. (in Russian)]
42. Afshar K., Stothers L., Scott H., MacNeily A.E. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J. Urol. 2012; 188(4, Suppl.): 1584-7.
43. Katsargyris A., Tampaki E.C., Giaginis C., Theocharis S. Cranberry as promising natural source of potential anticancer agents: current evidence and future perspectives. Anticancer Agents Med. Chem. 2012; 12(6): 619-30.
44. Rouhi-Boroujeni H., Heidarian E., Rouhi-Boroujeni H., Khoddami M., Gharipour M., Rafieifan-Kopaei M. Use of lipid-lowering medicinal herbs during pregnancy: A systematic review on safety and dosage. ARYA Atheroscler. 2017; 13(3): 135-55.
45. Heitmann K., Nordeng H., Holst L. Pregnancy outcome after use of cranberry in pregnancy: Тhe Norwegian mother and child cohort study. BMC Complement. Altern. Med. 2013; 13: 345.
Received 08.12.2017
Accepted 22.12.2017
About the Authors
Bakhareva Irina Viktorovna, MD, Professor of the Department of Obstetrics and Gynecology of the Faculty of Physiotherapy, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. E-mail: iribakhareva@yandex.ruFor citations: Bakhareva I.V. Urinary tract infections in pregnant women: prevention and treatment. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (3): 129-37. (in Russian)
https://dx.doi.org/10.18565/aig.2018.3.129-137
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