Ovalle A, Levancini M
Department of Obstetrics and Gynecology, San Borja Arriarán Clinical Hospital, Santiago, Chile.
Curr Opin Urol. 2001 Jan;11(1):55-9. doi: 10.1097/00042307-200101000-00008.
Urinary tract infections are very common during pregnancy. Escherichia coli is the most common pathogen isolated from pregnant women. Ampicillin should not be used because of its high resistance to Escherichia coli. Pyelonephritis can cause morbidity and can be life-threatening to both mother and fetus. Second and third-generation cephalosporins are recommended for treatment, administered initially intravenously during hospitalization. Cultures and the study of virulence factors of uropathogenic Escherichia coli are recommended for the adequate management of pyelonephritis. The lower genital tract infection associated with pyelonephritis is responsible for the failure of antibiotic treatment. Asymptomatic bacteriuria can evolve into cystitis or pyelonephritis. All pregnant women should be routinely screened for bacteriuria using urine culture, and should be treated with nitrofurantoin, sulfixosazole or first-generation cephalosporins. Recurrent urinary infection should be treated with prophylactic antibiotics. Pregnant women who develop urinary tract infections with group B streptococcal infection should be treated with prophylactic antibiotics during labour to prevent neonatal sepsis. Preterm delivery is frequent. Evidence suggests that infection plays a role in the pathogenesis of preterm labour. Experimental models in pregnant mice support the theory that Escherichia coli propagated by the transplacental route, involving bacterial adhesins, induces preterm delivery, but this has not been demonstrated in humans. Ascending lower genital tract infections are the most probable cause of preterm delivery, but this remains to be proved.
尿路感染在孕期非常常见。大肠埃希菌是从孕妇中分离出的最常见病原体。由于大肠埃希菌对氨苄西林耐药性高，故不应使用该药。肾盂肾炎可导致发病，对母亲和胎儿都可能危及生命。推荐使用第二代和第三代头孢菌素进行治疗，住院期间最初采用静脉给药。为了对肾盂肾炎进行充分管理，建议对尿路致病性大肠埃希菌进行培养和毒力因子研究。与肾盂肾炎相关的下生殖道感染是抗生素治疗失败的原因。无症状菌尿可发展为膀胱炎或肾盂肾炎。所有孕妇都应常规进行尿培养以筛查菌尿，并用呋喃妥因、磺胺异恶唑或第一代头孢菌素进行治疗。复发性尿路感染应使用预防性抗生素治疗。发生B族链球菌感染的尿路感染孕妇，分娩时应使用预防性抗生素治疗以预防新生儿败血症。早产很常见。有证据表明感染在早产的发病机制中起作用。孕鼠实验模型支持以下理论：通过胎盘途径传播的大肠埃希菌，涉及细菌黏附素，可诱发早产，但这在人类中尚未得到证实。下生殖道上行感染是早产最可能的原因，但这仍有待证实。
