Andriole V T, Patterson T F
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Med Clin North Am. 1991 Mar;75(2):359-73. doi: 10.1016/s0025-7125(16)30459-x.
The urinary tract undergoes profound physiologic and anatomic changes during pregnancy that facilitate the development of symptomatic UTIs in women with bacteriuria. Although the adverse effects of asymptomatic bacteriuria on maternal and fetal health continue to be debated, it is clear that asymptomatic bacteriuria is the major risk factor for developing symptomatic UTI and that symptomatic infections are associated with significant maternal and fetal risks. Because the majority of symptomatic UTIs develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy is as effective as prolonged therapy and should be followed with a repeat culture to document clearing of the bacteriuria. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a complete urologic evaluation after delivery.
孕期尿路会经历深刻的生理和解剖学变化，这使得菌尿症女性更容易发生有症状的尿路感染。尽管无症状菌尿症对母婴健康的不良影响仍存在争议，但很明显，无症状菌尿症是发生有症状尿路感染的主要危险因素，且有症状感染与显著的母婴风险相关。由于大多数有症状的尿路感染发生在孕期早期患有菌尿症的女性中，因此对菌尿症进行治疗以预防有症状感染。所有女性在首次产前检查时都应接受筛查，使用试纸条培养法可可靠且廉价地完成此项检查。短程治疗与长程治疗同样有效，治疗后应再次进行培养以证实菌尿已清除。反复治疗未能消除菌尿症或同一病原体复发提示存在肾实质感染或结构异常。所有持续存在菌尿症或反复感染的女性在分娩后都应进行随访培养及全面的泌尿系统评估。
