Urinary tract infections during pregnancy – clinical picture and therapeutic approach in the Infectious Diseases Hospital of Iaşi (2009-2012)

Background

Urinary tract infections in pregnancy represent one of the significant pathologies that can influence both the health of the mother and of the child, often giving rise to a polymorphic clinical picture and posing therapeutic difficulties, due to antibiotic resistance and drug toxicity.

Methods

We performed a retrospective study on 60 pregnant patients, diagnosed with urinary infections in the Clinic Hospital of Infectious Diseases of Iaşi, between January 2009 and December 2012.

Results

The annual number of the admissions was relatively constant, except for the year 2010 with 25 cases; the infections were more frequent in 26-40 years old pregnant women (63.3%), during the first (38.3%) and the second trimester of pregnancy (48.3%) and in primiparous women (61.7%). Fever was present in 71.7% of the patients, 51.7% having also digestive symptomatology. The inflammatory syndrome was illustrated at admission through leukocytosis (in 66.7% cases), high values of ESR (88.9% cases), and of fibrinogen (31% of cases). Pyuria was present in 75% of cases, and in 25.7% were associated albuminuria. 65% cases were considered lower urinary tract infections. The etiology was established in 73.3% cases, being dominated by E coli (88.3%); also implicated were: Klebsiella spp. (6.7%), Streptococcus spp. (1.7%), Candida 3.3%. The etiologic treatment was based on beta-lactams, especially in association with beta-lactamase inhibitors: amoxicillin-clavulanate – 43.3%, ampicillin-sulbactam – 3.3%, second generation cephalosporins – 16.7% or third generation cephalosporins (18.3%) and carbapenems – 10%. The evolution was favorable in all the cases, with no immediate negative effects on the baby.

Conclusion

The urinary tract infections were more frequent during the first months of pregnancy, in primiparous women older than 26 years old, the etiology being dominated by E coli with a decreased antibiotic susceptibility in the last years.