Schnarr J, Smaill F
Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Eur J Clin Invest. 2008 Oct;38 Suppl 2:50-7. doi: 10.1111/j.1365-2362.2008.02009.x.
Symptomatic and asymptomatic bacteriuria is common in pregnant women. A history of previous urinary tract infections and low socioeconomic status are risk factors for bacteriuria in pregnancy. Escherichia coli is the most common aetiologic agent in both symptomatic and asymptomatic infection and quantitative culture is the gold standard for diagnosis. Treatment of asymptomatic bacteriuria has been shown to reduce the rate of pyelonephritis in pregnancy and therefore screening for and treatment of asymptomatic bacteriuria has become a standard of obstetrical care. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of low birth weight, but the methodological quality of the studies limits the strength of the conclusions that can be drawn. Debate exists in the literature as to whether treated pyelonephritis is associated with adverse fetal outcomes. There is no clear consensus in the literature on antibiotic choice or duration of therapy for infection. With increasing antibiotic resistance, consideration of local resistance rates is necessary when choosing therapy.
有症状和无症状菌尿在孕妇中很常见。既往有尿路感染病史和社会经济地位低下是孕期菌尿的危险因素。大肠埃希菌是有症状和无症状感染中最常见的病原体，定量培养是诊断的金标准。已证明治疗无症状菌尿可降低孕期肾盂肾炎的发生率，因此筛查和治疗无症状菌尿已成为产科护理的标准。无症状菌尿的抗生素治疗与低出生体重发生率的降低有关，但研究的方法学质量限制了所能得出结论的力度。关于治疗后的肾盂肾炎是否与不良胎儿结局相关，文献中存在争议。关于感染的抗生素选择或治疗持续时间，文献中尚无明确共识。随着抗生素耐药性的增加，选择治疗方法时必须考虑当地的耐药率。
