Interventions for preventing recurrent urinary tract infection during pregnancy

Abstract

Background Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may cause serious adverse pregnancy outcomes for both mother and child including preterm birth and small-for-gestational-age babies. Interventions used to prevent RUTI in women who are pregnant can be pharmacological (antibiotics) or non-pharmacological (cranberry products, acupuncture, probiotics and behavioural modifications). So far little is known about the best way to prevent RUTI in pregnant women. Objectives To assess the effects of interventions for preventing RUTI in pregnant women. The primary maternal outcomes were RUTI before birth (variously defined) and preterm birth (before 37 weeks). The primary infant outcomes were small-for-gestational age and total mortality. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2015) and reference lists of retrieved articles. Selection criteria Published, unpublished and ongoing randomised controlled trials (RCTs), quasi-RCTs, clustered-randomised trials and abstracts of any intervention (pharmacological and non-pharmacological) for preventing RUTI during pregnancy (compared with another intervention, placebo or with usual care). Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. 1 Interventions for preventing recurrent urinary tract infection during pregnancy (Review)

Urinary Tract Infection and Bacteriuria in Pregnancy

“…2,120,121 Daily prophylactic therapy with 50 to 100 mg of nitrofurantoin should also be considered. Although there is limited highquality evidence that antimicrobial prophylaxis decreases bacteriuria in pregnancy, 122,123 this is a well-established therapy in nonpregnant patients. 124 Postcoital prophylaxis can also be considered.…”

“…35 Follow-up, including periodic screening for recurrent bacteriuria and consideration of daily antimicrobial prophylactic therapy, is also recommended after treatment. [122][123][124][125] …”

“…Prophylactic antimicrobial therapy should be strongly considered to reduce the risk of recurrent pyelonephritis. [122][123][124][125]137 In a study of 400 pregnant patients with pyelonephritis, 2.7% of women were readmitted for recurrent pyelonephritis, all of whom were noncompliant with antimicrobial prophylaxis, reinforcing the importance of this therapy. 17 In patients who do not respond to culturedirected treatment, alternative diagnoses should be considered and an imaging study such as a renal ultrasound should be obtained to rule out renal abscess, nephrolithiasis, or other structural abnormality, although it is important to remember that some degree of hydronephrosis is expected in pregnancy.…”

Asymptomatic bacteriuria: prevalence rates of causal microorganisms, etiology of infection in different patient populations, and recent advances in molecular detection

“…In contrast to sUTI, which is resolved in most cases by treatment (Hooton, 2003;Gupta et al, 2011), therapy is not routine for ABU (Nicolle et al, 2005;Nicolle, 2006). While treatment can halt the progression of bacteriuria and reduce the incidence of infection (Schneeberger et al, 2012), patients infected with E. coli experience recolonization with the same or similar organism at surprisingly high rates (Dalal et al, 2009). These data reveal the difficulty in achieving bacteriological cure for ABU and imply that bacteriuria involves frequent recolonization of the host.…”

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

“…5,6 However, similar to ours, several studies have suggested that the risk of early delivery among women with a UTI persists despite treatment. 11,25,26 We showed that women were at elevated risk of PTB regardless of treatment when the UTI was diagnosed at an inpatient or outpatient visit within 6 months of delivery. This suggests that treatment may not adequately halt the inflammatory cascade leading to PTB, and that infection early in pregnancy is still associated with early parturition months later.…”