Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Clin Microbiol Infect. 2023 Oct;29(10):1249-1253. doi: 10.1016/j.cmi.2022.08.015. Epub 2022 Aug 27.
Urinary tract infections (UTIs) are the most common infection among pregnant women and have been associated with maternal and foetal complications. Antimicrobial exposure during pregnancy is not without risk. International guidelines recommend a single screen-and-treat approach to asymptomatic bacteriuria (ASB); however, this approach has been questioned by recent studies.
The aim of this narrative review was to assess the pathophysiology, current risk factors and management of UTI during pregnancy, its impact on pregnancy outcomes, and to develop recommendations on the best use of antimicrobials.
PubMed, Cochrane database, and ClinicalTrials.gov.
Owing to the physiological changes related to pregnancy, pregnant women are at higher risk of UTI. All types of UTIs combined have been estimated to affect approximately 2% to 15% of women. ASB affects 2% to 7% of pregnant women. Recent studies do not provide good-quality evidence for an association between ASB and acute pyelonephritis if ASB is untreated. There is low-to-moderate-quality evidence that treatment of ASB results in a reduction in the incidence of low birth weight and preterm birth, which justifies screening practices for ASB with only a single urine culture in the first trimester. If the clinician opts for treatment, a short course of β-lactams, nitrofurantoin, or fosfomycin should be favoured. Studies on cystitis during pregnancy are limited. Acute pyelonephritis has been shown to be associated with increased maternal complications and in some studies has also been associated with preterm delivery and low birth weight. Preferred antimicrobials for the management of pyelonephritis are amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems. Studies on recurrent UTIs during pregnancy are limited, making it difficult to draw conclusions regarding prophylactic measures.
Further research is required to understand the true incidence of ASB-related complications and the benefit and modalities of screening for ASB and to further explore prophylactic measures.
尿路感染（UTI）是孕妇中最常见的感染，与母婴并发症有关。孕妇在怀孕期间使用抗菌药物并非没有风险。国际指南建议对无症状菌尿（ASB）采用单一筛查和治疗方法；然而，最近的研究对这种方法提出了质疑。
本叙述性综述旨在评估孕妇尿路感染的病理生理学、当前的危险因素和管理、其对妊娠结局的影响，并就抗菌药物的最佳使用提出建议。
PubMed、Cochrane 数据库和 ClinicalTrials.gov。
由于与妊娠相关的生理变化，孕妇尿路感染的风险更高。所有类型的 UTI 合并估计影响约 2%至 15%的女性。ASB 影响 2%至 7%的孕妇。最近的研究没有提供高质量的证据表明，如果不治疗 ASB，ASB 与急性肾盂肾炎之间存在关联。有低至中等质量的证据表明，治疗 ASB 可降低低出生体重和早产的发生率，这证明了仅在妊娠早期进行一次尿液培养的 ASB 筛查实践是合理的。如果临床医生选择治疗，应首选短疗程的β-内酰胺类、呋喃妥因或磷霉素。关于妊娠期膀胱炎的研究有限。急性肾盂肾炎与产妇并发症增加有关，在一些研究中还与早产和低出生体重有关。管理肾盂肾炎的首选抗菌药物是阿莫西林联合氨基糖苷类、第三代头孢菌素或碳青霉烯类。关于妊娠期复发性尿路感染的研究有限，难以得出关于预防措施的结论。
需要进一步研究以了解 ASB 相关并发症的真实发生率以及筛查 ASB 的益处和方式，并进一步探索预防措施。
