Should urinary tract infections be detected and treated?

• Devyatova E.A.

Abstract

Urinary tract infection (UTI) is one of the most widely spread gestational complications and its occurrence is up to 15% [2]. In absence of management of asymptomatic bacteriuria patients develop pyelonephritis in ¹/₃ of cases [6]. There is a strong correlation between post-defloration cystitis and untreated UTI, pyelonephri­tis and prematurity [1, 5]. Pregnancy is already a risk factor for TUI by the reason of the list of specific changes in anatomy and physiology of urinary tract during gestation.

Prophylaxis and timely management of TUI can decrease the amount of infectious complications and im­prove the maternal and neonatal outcomes. A search of the best strategies for management of pregnancies complicated with UTI is staying an actual question. It requires evaluation and analysis of efficacy of modern diagnostic, prophylactic and clinical approaches to UTI during pregnancy.

Objective: 1) deterioration of risk factors for UTI; 2) discussion of importance of screening for UTI during pregnancy; 3) evaluation of diagnostic approach to UTI; 4) discussion of modern principles of prophylaxis and management of UTI.

Conclusion. The most important of risk factors for UTI are anamnesis of urinary tract disease or UTI, meta­bolic syndrome, diabetes mellitus, nonobservance of hygienic standards in labor, urethral catheterization.

Screening for UTI should be performed in the 1st trimester already. Routine assessment should include testing of the middle portion of urine, clinical and biochemical blood tests; if there is pyelonephritis screening of peripheral blood for septicemia is favorable.

Antenatal prophylaxis should include: 1) patient's learning about the clinical signs of UTI and its complica­tions; 2) explanation of the role of screening for UTI and the right way to collect urine for the test; 3) obser­vation of compliance in taking the drug is important in the cases of administration of antibacterial therapy for prevention of UTI recurrence. Prophylaxis of UTI during labor should include a sufficient amount of fluid for drinking, good personal hygiene; if urethral catheterization is performed there should be a good technology of care also.

Any kind of UTI deserves antibacterial therapy and following monitoring during pregnancy to decrease the risk of complications and unfavorable maternal and neonatal outcomes. The effectiveness of treatment of UTI depends on patient's compliance strongly.

Keywords:pregnancy, pyelonephritis, urinary tract infection, bacteriuria, risk factors, antibiotics, prophylaxis, management

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)