What is asymptomatic bacteriuria in pregnant women, adults and children and why is it dangerous? Bacteriuria during pregnancy: symptoms, treatment, effects on the fetus Bacteriuria during pregnancy, effects on the fetus

Bacteria in the urine during pregnancy is the body's signal of pathological processes that require treatment and medical attention. Consider the main causes of bacteria in the urine, diagnostic methods, symptoms and methods of treatment.

During pregnancy, a woman has to take a lot of tests that allow you to monitor the health of the expectant mother and her child. Urinalysis is considered one of the most important. Bacteria in the urine occur very often, but there is no clear explanation for this phenomenon. Therefore, there is such a thing as bacteriuria of pregnant women.

The presence of bacteria may indicate inflammation in the kidneys. It can be cystitis, pyelonephritis and other diseases, the risk of which increases during pregnancy. But, neither for the expectant mother, nor for her unborn child, such a state does not benefit. And in some cases, it can lead to pathological consequences. A particular danger arises with asymptomatic bacteriuria, in this case, the disease proceeds without any manifestations.

Many doctors claim that bacteria in the urine found during gestation indicate a high risk of preterm birth. Very often found in the urine: Escherichia coli in 80% of cases, Klebsiella, Proteus, Streptococcus, Enterobacter, Fecal Enterococcus, Staphylococcus and others. Each of the cases requires treatment and medical attention.

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Causes of bacteria in urine during pregnancy

The causes of bacteria in the urine during pregnancy are very diverse. The ever-increasing uterus puts pressure on the kidneys, disrupts their normal functioning, and leads to the appearance of harmful microorganisms. Bacteria can appear due to hormonal changes in a woman's body and with physiological features: a short urethra, the ureter is located close to the rectum.

Bacteria appear in women who have sex with many partners, do not maintain personal hygiene at the proper level. In some cases, bacteriuria appears with STDs, diabetes mellitus, chronic lesions of the body and pathologies of the urinary system. Sometimes a weakened immune system and cavities lead to bacteria in the urine.

There are two types of bacteria in the urine: true bacteriuria occurs when the bacteria multiply on their own and live in the urine. With false bacteriuria, bacteria enter the urine from distant foci of infection through the blood. The increased content of harmful microorganisms is accompanied by clinical manifestations, but in some cases they do not cause side symptoms.

Bacteria occur in chronic diseases that recur and worsen during pregnancy, consider some of them:

• cystitis during pregnancy

Inflammation of the walls of the bladder is the most common urological lesion of both infectious and infectious nature. Infectious cystitis occurs due to opportunistic microflora. Non-infectious cystitis appears with weakened immunity, hypothermia, intestinal dysbacteriosis, overwork. In some cases, vaginal dysbiosis and bladder irritation with chemicals lead to bacteria in the urine.

If before pregnancy a woman had manifestations of cystitis, then the bacteria found in the urine indicate its recurrence. The symptomatology of the disease manifests itself as frequent urge to urinate, which is very painful. A woman has pulling pains in the lower abdomen, blood in the urine and fever. If you experience these symptoms, you should seek medical attention.

• Pyelonephritis during pregnancy

Inflammatory process in the renal pelvis. Escherichia coli, Staphylococcus aureus, Streptococcus, Candida fungi, Pseudomonas aeruginosa are the causes of the disease. An infectious focus is any inflammatory-purulent process. Pyelonephritis can be primary - occurs at the first signs of pregnancy and secondary - manifests itself even before pregnancy and worsens against the background of hormonal changes.

Bacteria in the urine caused by inflammation of the kidneys appear due to the growth of the uterus, which pushes the adjacent internal organs. With an exacerbation of the disease, a woman experiences acute pain in the lumbar region, chills, cramps during urination, signs of intoxication. Pyelonephritis requires mandatory treatment, as the disease is dangerous for the expectant mother and her child.

In addition to the above reasons, there are also risk groups. So, dental problems can lead to bacteria in the urine, irregular hygiene, diabetes mellitus, chronic diseases of the urogenital area, pathologies of the urinary system and sexually transmitted diseases are the main risk factors and causes of bacteriuria.

• Urethritis

A bacterial inflammatory disease that affects the walls of the urethra. The disease is very common and most often affects pregnant women, causing bacteria in the urine. Bacterial urethritis occurs due to harmful microorganisms entering the urethra (E. coli, enterococci, staphylococci and streptococci). If a pregnant woman has chlamydia, then this is another cause of urethritis, which can lead to damage to the amniotic fluid and the embryo.

The peculiarity of urethritis is that the pathogens are constantly on the mucous membranes of the urinary tract. Therefore, the task of the expectant mother and her doctor is to identify predisposing factors and eliminate them. The disease and bacteria in the urine against its background can appear with injuries and narrowing of the urethra, bladder catheterization and cystoscopy. The bacterial form of the disease can be caused by specific pathogenic microorganisms that destroy the local defenses of the woman's body.

Symptoms of bacteria in the urine during pregnancy

Symptoms of bacteria in the urine during pregnancy depend on the cause of the disease. Bacteriuria appears in 10% of pregnant women, the danger is that it can be asymptomatic. Against the background of bacteria in the urine, a woman has nephrolithiasis and dilation of the ureter. Very often, this symptomatology occurs in the third trimester of pregnancy. Bacteria can cause low birth weight babies, miscarriages and premature births.

With bacteria, various harmful microflora are found: Escherichia and Pseudomonas aeruginosa, Proteus, Streptococcus, Staphylococcus and other microorganisms. Very often, bacteria appear in inflammatory diseases of the kidneys and urinary system, infectious lesions of the body. Harmful microorganisms can enter the urinary tract and kidneys through the hematogenous route.

Symptoms of bacteria in the urine during pregnancy are similar to those of cystitis and pyelonephritis. A woman has a fever, frequent and painful urge to urinate, urine with sediment and cloudy. If such symptoms appear, it is necessary to seek medical help, determine the cause of discomfort and eliminate it.

If bacteria in the urine arose due to urethritis, a woman develops purulent and mucopurulent discharge from the urethra, pain and discomfort when urinating. In acute inflammation of the urethra, the bacteria in the urine becomes chronic. Bacteria can hide in the Bartholin's glands, which are located in the vestibule of the vagina. With a decrease in the protective properties of the immune system, bacteria are activated and cause painful symptoms and can be detected in a urine test.

Diagnosis of bacteria in the urine during pregnancy

Diagnosis of bacteria in the urine during pregnancy is carried out every month, as the expectant mother regularly takes tests. This allows you to maintain the health of a woman and her unborn baby. For diagnosis, a reduction glucose test, a Griess nitrite test and other methods are used.

Since the diagnosis is carried out in a polyclinic, doctors conduct chemical tests that give quick results. Bacteriological methods determine the number of colonies of microbes and the degree of bacteriuria. If bacteriuria arose against the background of colonization of the periurethral region that appeared before pregnancy, then the disease is considered as a risk factor for acute pyelonephritis.

Consider the main stages of the diagnosis of bacteria in the urine during pregnancy:

• Instrumental and laboratory studies - ultrasound examination of the kidneys, blood and urine tests, excretory and survey urography, dopplerometry of renal vessels, screening tests.
• Differential diagnosis - doctors conduct a complete diagnosis of the body of a pregnant woman in order to determine the diseases that caused the bacteria in the urine and to identify asymptomatic bacteriuria.

In addition to diagnostic methods, a woman should consult a nephrologist, therapist, urologist and gynecologist. This will provide a complete picture of the causes of the disease and will allow you to draw up an effective treatment plan.

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Treatment of bacteria in the urine during pregnancy

Treatment of bacteria in the urine during pregnancy depends on the results of the diagnosis. But every expectant mother should undergo treatment. There are several methods of treatment, consider the main ones:

• Non-drug treatment

• Medical treatment

This type of treatment is carried out both with overt and asymptomatic bacteriuria. A woman is prescribed a course of treatment for 1-3 weeks with cephalosporins, antimicrobial agents and ampicillin. Such a course of treatment is explained by the fact that during pregnancy a single dose of drugs is not enough. All drugs are selected empirically. Mandatory is antibiotic therapy, followed by monthly bacteriological studies of urine. A woman may be prescribed maintenance therapy until the end of pregnancy and within 14 days of the postpartum process. This will help prevent recurrence of bacteriuria.

The peculiarity of treatment also depends on complications during pregnancy. Consider the complications of gestation by trimester:

• Bacteria in the urine found in the first trimester can cause pregnancy termination. For therapeutic purposes, standard therapy is used.
• With bacteriuria in the second and third trimesters, a woman is given oncoosmotherapy to maintain pregnancy. If the bacteria become a threat of preterm labor, the pregnant woman is given tocolytic therapy.

If bacteria in the urine appeared due to urethritis, then the woman is given antibiotic therapy and uroantiseptics. The drug Monural is highly effective, which can be taken only if the therapeutic benefit for the mother is more important than the possible risk to the fetus. Urethritis and bacteria in the urine are treated with Azithromycin, Doxycycline, Phytolysin, or Kanefron. The drug is selected by the attending physician and its intake is strictly controlled.

In many cases, bacteria in the urine is determined even before pregnancy. The frequency of occurrence of this disease is affected by the state of the urinary tract and the sphincter mechanism of the bladder. In the treatment of bacteriuria in early pregnancy, in 80% of cases it is possible to cure the disease without consequences for the body of the mother and child, in 5-7% of cases the bacteria lead to miscarriages and prematurity.

Prevention of bacteria in the urine during pregnancy

Prevention of bacteria in the urine during pregnancy is a method to prevent the development of the disease and protect the body of the expectant mother. Taking care of your health and the health of your unborn child is the top priority for every woman. To prevent bacteriuria, the expectant mother needs:

• Regularly donate urine for analysis, for the reliability of the results it is necessary to use only sterile containers. Before testing, it is forbidden to drink alcohol, spicy and salty foods. Urine should be collected after washing, in the morning. Please note that no more than 2 hours should elapse from the moment the urine is collected to the laboratory test, as the composition of the urine changes.
• A pregnant woman should observe the hygiene of the genitals and refuse synthetic underwear. Synthetic underwear provokes the growth of pathogenic microorganisms, contributes to the development of candidiasis and the appearance of bacteria in the urine in an ascending manner.
• Compliance with the recommendations of the doctor, regular examinations and taking prescribed medications will help protect against pathological changes during pregnancy.
• Prevention of urethritis, which caused bacteria in the urine, should begin with good hygiene and a healthy lifestyle. Regular check-ups at the gynecologist and an orderly sex life are the best methods of prevention.

According to medical statistics, bacteria in the urine during pregnancy are found in every fifth woman. Timely diagnosis and treatment - can successfully cure bacteriuria.

The prognosis of bacteria in the urine during pregnancy

The prognosis of bacteria in the urine during pregnancy depends on when the pathology was detected. If the bacteria are detected in the early stages, then the prognosis is favorable, as doctors prescribe treatment that prevents the threat of miscarriage. With bacteriuria in the last months of pregnancy, the prognosis depends on the type of bacterial lesion and its cause.

If the bacteria appeared due to an exacerbation of chronic diseases or physiological characteristics of the body, then the expectant mother is prescribed maintenance therapy and the prognosis of bacteria in the urine is favorable. But if a woman does not treat bacteriuria, then this can cause serious consequences. In bacteria and urethritis, the prognosis depends on early diagnosis and treatment. The earlier the disease is detected, the better the prognosis, even with purulent and gonorrheal urethritis.

Bacteria in the urine during pregnancy is a problem that requires special attention and treatment. Timely diagnosis and therapy is the key to the health of the expectant mother and her child.

It is important to know!

Forced diuresis as a method of detoxification is based on the use of drugs that promote a sharp increase in diuresis, this is the most common method of conservative treatment of poisoning, in which the elimination of hydrophilic toxicants is carried out mainly by the kidneys.

Asymptomatic bacteriuria - bacteriuria, quantitatively corresponding to the true (more than 100,000 bacteria in 1 ml of urine) in at least two samples in the absence of a clinical picture of infection.

SYNONYMS

Asymptomatic, chronic latent bacteriuria.
ICD-10 CODE
There is no separate ICD-10 code.

EPIDEMIOLOGY

Asymptomatic bacteriuria is detected in 6% (2–11%) of pregnant women, depending on their socioeconomic status.

In many cases, bacteriuria precedes pregnancy, and it is noted with approximately the same frequency in pregnant and non-pregnant women.

The frequency of asymptomatic bacteriuria increases in parallel with the intensity of sexual activity and depends on the socioeconomic status (with a low socioeconomic status, bacteriuria is noted 5 times more often).

Pregnant women with bacteriuria (especially with low efficacy of therapy) often (in 8-33% of cases) reveal radiographic signs of chronic pyelonephritis, as well as congenital malformations of the urinary tract, nephrolithiasis, and dilatation of the ureter.

PREVENTION

The list of mandatory methods of dispensary examination, which should be repeated monthly, should include clinical and biochemical blood and urine tests, bacteriological examination of urine, ultrasound of the kidneys and fetus. Conducting courses of antibiotic therapy reduces the risk of development of purulent forms of acute pyelonephritis, fetal malnutrition and premature birth, which occur in more than 30% of pregnant women with untreated bacteriuria.

SCREENING

As a screening test for mass examinations of pregnant women, the reaction with triphenyltetrazolium chloride is the most simple and economically justified. The number of positive results of this test in determining true bacteriuria (105 or more in 1 ml of urine) is 90% or more.

In order to prevent acute pyelonephritis, all pregnant women during their first visit to the antenatal clinic should be referred for bacteriological examination of urine.

ETIOLOGY (CAUSES) OF ASSYMPTOM BACTERIURIA

Basically, with asymptomatic bacteriuria, Escherichia coli is found. Less commonly, other members of the Enterobacteriaceae family (Klebsiella, Enterobacter, Proteus), as well as Staphylococcus epidermidis, Staphylococcus saprophyticus, Enterococcus faecalis, and group B streptococci (GBS) are isolated.

PATHOGENESIS

The persistence of bacteriuria is facilitated by both the characteristics of the pregnant woman's body [defects in local defense mechanisms (insufficient production of neutralizing antibodies) and glycosuria, which accelerates bacterial growth], and the properties of the microorganism with a certain virulence (adhesins, hemolysin, etc.).

PATHOGENESIS OF GESTATION COMPLICATIONS

Pregnancy does not contribute to an increase in the frequency of bacteriuria, but to the development of pyelonephritis due to changes in the anatomical and functional state of the urinary tract: expansion of the pyelocaliceal system of the kidney and insufficiency of the sphincter mechanism of the bladder.

Factors predisposing to the development of bacteriuria during pregnancy, arising from the action of progesterone on the muscle tone of the ureters and their mechanical obstruction by the growing uterus, are presented below.

· Deceleration of the passage of urine due to a decrease in the tone and peristalsis of the ureters.
Expansion of the renal pelvis and upper ureters with the formation of physiological hydronephrosis of pregnant women.
Decreased bladder tone, increased residual urine, which contributes to vesicoureteral reflux and upward migration of bacteria into the upper urinary tract.
Changes in the physical and chemical properties of urine that promote bacterial growth (increase in pH, estrogen concentration, glucosuria is possible).

It should be noted that the tissues of the renal medulla are especially susceptible to infection, since the hypertonic environment in them prevents the migration of leukocytes, phagocytosis, and the action of the compliment.

Bacteriuria has not been shown to predispose to anemia, hypertension, preeclampsia, chronic kidney disease, amnionitis, or endometritis.

In pregnant women with bacteriuria, an increased frequency of spontaneous abortions and stillbirths was noted, and the treatment of the disease does not significantly affect this dependence.

The level of neonatal mortality and prematurity increases by 2-3 times. Asymptomatic bacteriuria may be the cause of preterm labor, since locally or systemically synthesized PGs are important mediators of uterine contractile activity.

CLINICAL PICTURE (SYMPTOMS) OF BACTERIURIA

Asymptomatic bacteriuria has no significant clinical significance. In the vast majority of cases, bacteriuria in pregnant women can be diagnosed at the first visit to the doctor in the early stages of pregnancy, and only in 1% of cases bacteriuria develops at a later date.

COMPLICATIONS OF GESTATION

Threat of abortion.
Anemia in pregnancy.
· Gestosis.
The risk of preterm birth.
placental insufficiency.
· ZRP.
Fetal death.

DIAGNOSTICS OF ASSYMPTOM BACTERIURIA IN PREGNANCY

The mandatory methods of examination during dispensary observation, which should be carried out monthly for all pregnant women, include clinical and biochemical blood and urine tests, bacteriological examination of urine, ultrasound of the kidneys and fetus. Conducting courses of antibiotic therapy helps to reduce the risk of developing purulent forms of acute pyelonephritis, fetal malnutrition and premature birth, which occur in more than 30% of pregnant women with untreated bacteriuria.

ANAMNESIS

In most patients, bacteriuria results from pre-pregnancy periurethral colonization and is considered a risk factor for acute gestational pyelonephritis in 30–40% of women with untreated pre-pregnancy bacteriuria.

LABORATORY RESEARCH

· General blood analysis.
· Blood chemistry.
· General urine analysis.
Urine analysis according to Nechiporenko.
· In order to prevent acute pyelonephritis, all pregnant women during their first visit to the antenatal clinic are shown bacteriological examination of urine. Bacteriuria is diagnosed in the presence of growth (100,000 CFU / ml or more) of the same microorganism in 2 crops of an average portion of urine collected in compliance with the rules of asepsis, taken with an interval of 3-7 days (minimum 24 hours).

As a screening test for mass examinations of pregnant women, it is recommended to carry out a reaction with triphenyltetrazolium chloride. The sensitivity of this examination method in terms of determining true bacteriuria (100,000 or more bacteria in 1 ml of urine) exceeds 90%.

INSTRUMENTAL STUDIES

· Ultrasound of the kidneys.
· Dopplerometry of the vessels of the kidneys.
Survey and excretory urography (according to indications).

DIFFERENTIAL DIAGNOSIS

The cause of bacteriuria may be contamination of urine samples, which should be suspected if bacteriological examination reveals various pathogens or neuropathogenic microorganisms.

Asymptomatic bacteriuria may be a sign of bacterial vaginosis not diagnosed before pregnancy, which occurs in about 20% of pregnant women.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Therapist's consultation.
· Consultation of a urologist, nephrologist.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Pregnancy 12 weeks. The threat of abortion. Asymptomatic bacteriuria in pregnancy.

TREATMENT OF ASSYMPTOMIC BACTERIURIA DURING PREGNANCY

Treat all pregnant women with bacteriuria.

NON-DRUG TREATMENT

MEDICAL TREATMENT OF BACTERIURIA IN PREGNANT WOMEN

The principles of medical treatment of asymptomatic bacteriuria are distinguished.

Short-term treatment (within 1–3 weeks) of oral ampicillin, cephalosporins, or nitrofurans is as effective (79–90%) as chronic antimicrobials.
In pregnancy, treatment with a "single dose" of the drug is not effective enough.
• The drug to start treatment is chosen empirically, since none of them has an advantage over others.
If bacteriuria is detected, treatment should begin with a course of antibiotic therapy for 3 days, followed by a monthly bacteriological examination of urine to monitor for a possible relapse of the disease.
· If bacteriuria is detected again (in 16-33% of cases), it is necessary to prescribe maintenance therapy (a single dose of the drug in the evening after meals) until the end of pregnancy and for another 2 weeks of the postpartum period.
It is recommended to prescribe maintenance treatment based on the sensitivity of microorganism detected in the urine to antibacterial agents.
A possible option for the management of pregnant women with recurrent bacteriuria is repeated short courses of uroseptics.

The main drugs for the treatment of asymptomatic bacteriuria during pregnancy:
Amoxicillin 250-500 mg 3 times a day for 3 days.
Amoxicillin + clavulanic acid 375-625 mg 2-3 times a day.
Cefuroxime 250-500 mg 2-3 times a day.
Ceftibuten 400 mg once a day.
Cephalexin 250-500 mg 4 times a day for 3 days.
Nitrofurantoin 100 mg 4 times a day for 3 days.

For the purpose of maintenance therapy, the following drugs are prescribed:
· Nitrofurantoin 100 mg at night.
Amoxicillin 250 mg at night.
Cephalexin 250 mg at night.
Fosfomycin at a dose of 3 g every 10 days.

PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS

Treatment of bacteriuria in early pregnancy prevents the development of pyelonephritis in 70–80% of cases, and in 5–10% of cases, prematurity.

FEATURES OF TREATMENT OF GESTATION COMPLICATIONS

Treatment of complications of gestation by trimester

In the first trimester, the threat of termination of pregnancy is possible. Treatment is traditional (see the relevant chapter).

With the development of PN, IGR and chronic hypoxia in the II and III trimester, appropriate therapy is prescribed. With the development of preeclampsia in the III trimester, oncoosmotherapy is carried out.

With the development of anemia in pregnant women, drugs are prescribed to compensate for iron deficiency, improve iron absorption in the digestive tract and improve metabolic processes. With the threat of premature birth, tocolytic therapy is used.

Treatment of complications in childbirth and the postpartum period

With the development of postpartum endometritis, drugs are prescribed aimed at eliminating the purulent-septic focus, reducing the manifestations of intoxication, correcting the COS, increasing the immune forces and resistance of the body, contractile activity of the myometrium, reducing the allergic manifestations of inflammation and tissue hypoxia.

TREATMENT EFFECTIVENESS ASSESSMENT

The effectiveness of treatment is evaluated by the results of bacteriological examination during each visit according to the following criteria.

· Recovery (sterile urine cultures or the presence of bacteria in the urine at a concentration of less than 10 cfu / ml).
Persistence of infection (detection of the same pathogen in the urine at a concentration of 10 CFU / ml or more).
Reinfection (detection of a new type of bacteria in the urine at a concentration of 10 CFU / ml or more during any visit).

CHOICE OF DATE AND METHOD OF DELIVERY

With timely preventive measures, childbirth occurs on time through the natural birth canal. CS is performed only for obstetric indications.

INFORMATION FOR THE PATIENT

In many cases, bacteriuria is noted before pregnancy, and its frequency is approximately the same in pregnant and non-pregnant women in this population.

The frequency of bacteriuria in pregnant women is influenced by the anatomical and functional state of the urinary tract: the expansion of the pyelocaliceal system of the kidney and the insufficiency of the sphincter mechanism of the bladder.

Treatment of bacteriuria in early pregnancy prevents the development of pyelonephritis in 70-80% of cases, and in 5-10% of cases - prematurity.

Urinalysis during pregnancy is given quite often, as it is one of the ways to assess the health of the expectant mother.

Before each scheduled visit to the gynecologist, it is desirable to obtain fresh results of the analysis, since it makes it possible to IT disorders in the genitourinary system, as well as pathologies in the body. If detected, reasons s are different, and these are not only diseases, but also improper hygiene before collecting material.

Throughout pregnancy, a woman's body changes. The child grows in the womb, and with it the stomach grows and the internal organs are squeezed. This does not affect their work in the best way, especially when it comes to the kidneys. When this paired organ is healthy, it constantly filters urine and removes it to the bladder. Ifin a pregnant womankidneys are compressed, urine stagnates, resulting in urine produces a lot of bacteria . Spreading, they lead to inflammation of the mucous membranes in different organs.

discover bacteria in the urine of pregnant womenpossible long before the disease begins to show symptoms. Means , timely examination is the only way to prevent the development of many pathologies, including preeclampsia.

Why are bacteria found in urine?

Strains bacteria in urine during pregnancycalled bacteriuria. It can be caused by various factors. In particular, pathogenic microorganisms spread due to changes in the woman's body - as mentioned above, the reason for this is the pressure on the kidneys of the enlarged uterus. Stagnation of urine leads to an increase in the number of pathogenic microorganisms in it.

Speaking of bacterial composition of urine, doctors distinguish between true and false bacteriuria. The first option is when bacteria settle and multiplyin pregnant urine, the second option is when bacterium brought with the bloodstream from the focus of infection in the body. Bacteriuria means that something is wrong in the body - perhaps diabetes mellitus, sexual infection, caries develop. In general, if such a condition is found, mean t, the body of a woman is weakened and prone to various misfortunes.

Pregnancy - a state that makes a woman happy, but at the same time characterized by anxiety. Oftenbacteria in urine during pregnancytalk about the presence of problems in the organs of the urinary system.

Relying on tests and symptoms, the doctor can detect such diseases.during pregnancy as:

• cystitis. This is a condition in which the lining in the bladder is inflamed and infected. More often in this condition found coli, less often - other infections;
• urethritis. The mucosa lining the urethra is inflamed. The analyzes maybacteria found(streptococcal and enterococcal infection, chlamydia and E. coli);
• pyelonephritis. Inflamed renal pelvis. Causes there may be the following - a fungus, the spread of Staphylococcus aureus, Escherichia coli and other pathogens.

What are the dangers of bacteria in the urine for a pregnant woman and a child

Throughout the period b pregnancy requires attention from doctors to the health of mother and child. In particular, asymptomatic bacteriuriacan cause complications in the pregnant woman and the fetus. More often doctors have to read inflammatory diseases of the genitourinary system. Treatment is given as soon as found Staphylococcus aureus, streptococcus, E. coli, etc.

The anatomy of a woman is such that the uterus and genitals are in close proximity, here why any infection can quickly spread through the birth canal. Violation of the outflow of urine is fraught with cystitis, urethritis, pyelonephritis.

If treatment is not prescribed on time, this is fraught with a severe form of preeclampsia (toxicosis), when pregnancy may be interrupted. In addition, the risk increases due to the fact that microorganisms enter the amniotic fluid. When swallowing water, the child is susceptible to intrauterine infection. Bacteriuria can cause malfunctions of the nervous and other systems of the child, sometimes leading to death.

Symptoms of bacteriuria

There is a certain norm various microorganisms, under which health is considered in order.

If a large number of bacteria are found in the urine, the doctor asks in detail about the symptoms.

Unfortunately, asymptomatic bacteriuria during pregnancy- not uncommon, and in this case it remains to be hoped for the regularity of tests and the professionalism of the doctor, his attentiveness to the health of the expectant mother.

As for the specific signs of bacteriuria, these are:

• pain when urinating;
• discomfort in the lower abdomen;
• strong smell of urine;
• an admixture of blood, pus in the urine, a change in its color to cloudy, brown;
• nausea, vomiting;
• pain in the lumbar region.

Symptoms can appear one at a time or several at once, sometimes disappear, but then return again, appearing even brighter.

Diagnosis in the presence of bacteria in the urine

Every month, pregnant women give urine for tests, thanks to which various diseases of an infectious and inflammatory nature can be detected in the early stages and successfully cured. Additionally, nitrite and glucose tests are carried out to identify the number and type of bacteria.

In addition to urine tests, a pregnant woman needs to undergo additional diagnostics that can identify the problem:

• dopplerometry of the vessels of the kidneys;
• examination of urine, blood;
• ultrasound examination (ultrasound) of the kidneys, ureters;
• analysis of a smear from the urethra.

In addition to the diagnostic measures listed above, a pregnant woman is recommended to consult a general practitioner, urologist and nephrologist. This will allow you to more accurately determine the problem, start therapy on time.

Treatment of bacteriuria in pregnancy

Doctors point out thattreatment during pregnancyshould be as safe as possible, but at the same time effective. The specific treatment regimen depends on the diagnosis, but the classic combination of interventions is as follows:

• nutrition correction with the addition of such foods and drinks that can reduce the acidity of urine. These are cereals, lean meat, vegetables;
• a normalized drinking regimen that allows you to increase the amount of urine excreted. This will quickly flush out the bacteria from the body;
• taking medications prescribed by a doctor.

Medications are prescribed for both symptomatic and asymptomatic bacteriuria. It is mandatory to take antibiotics. At the discretion of the doctor, he can choose Cefuroxime, Ceftazidime, Ampicillin, Doxycillin, etc. During pregnancy, antibiotics are taken strictly according to the doctor's prescription and only in a specific dosage. Additionally, the doctor may recommend taking herbal preparations, of which Canephron and Fitosilin are considered the most effective. The course of therapy lasts from 1 to 3 weeks, and if necessary, treatment is continued until childbirth and extended for 2 weeks after the baby is born.

Often, bacteria in women are detected in tests even before pregnancy. The best option would be to recover, and then plan motherhood. However, not everyone follows the recommendations of doctors, or even neglect regular examinations, as a result, they encounter bacteria in the urine already when carrying a child. What this leads to is described above. If you resort to numbers, during the 1st trimester of pregnancy, the treatment of bacteriuria ends successfully for 80% of women, for 5% it is sad (miscarriage occurs).

Prevention

To reduce the risk of infection of the body, especially during pregnancy, it is necessary to take preventive measures, which include the following measures:

• regular urine testing. It is carried out once a month, if there are indications, then more often. In some cases, improperly prepared containers or poorly collected material become the cause of the presence of bacteria in the urine. To prevent this from happening, you need to carefully follow the doctor's recommendations, do not eat spicy and salty foods the day before;
• proper hygiene of the genitals. Twice a day you need to wash yourself, in addition - after emptying the intestines. You need to wipe yourself from front to back, so as not to bring the infection from the anus to the urethra. It is better not to wear synthetic underwear, or refuse it at least for the period of pregnancy. Synthetics serve as an excellent "home" for bacteria, as they condense moisture and do not allow air to pass through;
• scheduled visits to the doctor, following the recommendations of a competent specialist.

Preventive measures will reduce the risk of infectious diseases of the genitourinary system. For pregnant women, this will be the key to the health of mother and baby.

One of the mandatory elements of a full examination of the body is a urine test. It is with the help of this study that it is possible to identify the presence of a wide variety of pathologies of the genital organs, organs of the urinary system and the small pelvis, various inflammations and neoplasms, as well as the presence of infection and bacteria.

This type of analysis is very informative and versatile, since there are no contraindications for it.

What is bacteriuria?

- a generally accepted medical term that denotes the presence of various types of microorganisms in urine. With the absolute health of a person, in the absence of any deviations from the norm, urine must be absolutely sterile. If, during the analysis, bacteria were found in the urine, this indicates violations in the work of the genitourinary organs.

The indicator that is used in this analysis is called the titer of microbial bodies. The normal indicator for an adult is 100,000 CFU / ml of urine (CFU - knee-forming units). If this indicator is higher, then there are microorganisms in the urine that are caused by an inflammatory infectious process of the urinary organs.

There are a variety of types of urine contamination, in which the CFU will be increased. The diagnosis of bacteriuria is made only in cases where the cause lies solely in the organs of the genitourinary system.

Causes of bacteria during pregnancy

The immune system of a woman during pregnancy is significantly weakened. This is because the body spends a large amount of energy, vitamins and trace elements on the formation of the fetus. Thus, the body becomes vulnerable and easily susceptible to microorganisms and infections, which do not pose any threat to a healthy person, since the immune system completely suppresses them.

The main reasons for the development of bacteriuria during pregnancy are chronic asymptomatic diseases, the relapse of which occurs with a sharp drop in the immune system:

The presence of pathogenic microorganisms in urine may be due to the peculiarities of the structure of the female genital organs, as well as in case of serious hormonal disorders.

Types of bacteriuria

As already mentioned, the presence of bacteria in the urine during pregnancy can be caused by various diseases of the genitourinary organs. These diseases have specific signs and symptoms. Depending on the degree of manifestation of such symptoms, two main types of bacteriuria are classified: true and latent (asymptomatic).

True

True bacteriuria is diagnosed in the presence of severe inflammatory processes in the urinary tract. All such inflammations are accompanied by purulent discharge containing a certain amount of bacteria. The infection that provoked inflammation, along with purulent masses, enters the urine through the kidneys or bladder.

In cases where these bacteria have chosen urine as a nutrient medium for themselves, they begin to actively multiply, affecting the urinary canals during urination. The most severe cases are characterized by the presence of more than 100,000 CFU / ml of urine, which poses a serious danger to human health.

Asymptomatic

Based on the name, it can be noted that this type of bacteriuria proceeds absolutely without symptoms. The patient does not feel any pain in the pelvic area and kidneys, does not experience discomfort during urination. The asymptomatic (hidden) form of bacteriuria can only be detected during a routine medical examination.

With this disease, there are no disturbances in the work of the genitourinary organs, the process of urination does not cause any concern. But still, if bacteriuria is detected out of time, there is a high risk of infection of the whole organism. Pregnant women are especially at risk, namely their children in the womb, who experience severe intoxication. Also, a girl can be a carrier of this infection, entering into an intimate relationship, especially when typhus is the root cause of the disease.

Ways to collect urine

Needless to say, pregnant women need to be constantly under medical examination. In order to eliminate the risk of developing genitourinary diseases or prevent their transition to more severe forms, a urine test must be taken every week, especially after the 18th week of pregnancy. It is during this period that all possible diseases have an increased effect on the developing fetus.

There are two main ways: by defecation and catheterization. The first method is very simple, it is enough to purchase a sterile container for collecting urine from a pharmacy and urinate into it, filling it by one third. The second method - catheterization, involves the introduction of a thin tube into the bladder through the ureters, which removes the required amount of urine directly from the place of its accumulation.

This method is more informative, since urine for analysis comes in pure form, without touching the walls of the urinary tract, which makes it possible to obtain more accurate results in the analysis. A huge disadvantage of such a study is the high risk of damage and infection of the walls of the ureters, which can lead to inflammation of the urinary canal, provoke urethritis.

Urine sampling is carried out exclusively in the morning, on an empty stomach.

Analysis methods

First, a woman takes a general and biochemical analysis. With the help of these studies, it is possible to determine the quality of stools, their color, the amount of protein, glucose, and red blood cells in them, the presence of an inflammatory process, possible infections and bacteria.

In cases where deviations were detected in the general analysis of urine, the number of microorganisms exceeds the permissible value, and the doctor suspects bacteriuria, a number of additional studies are prescribed. These include:

Principles of treatment during pregnancy

Treatment of the disease during pregnancy directly depends on the type of bacteria in the urine, although the principle remains the same. Like most viral and infectious diseases, therapy for bacteriuria in pregnant women consists of the following points:

Impact on the fetus of bacteriuria during pregnancy

Very often, the bacteriuria that develops during pregnancy is a symptom of bacterial vaginosis, diagnosed many years before the pregnancy itself, but due to changes in the immune system, a relapse of the disease has occurred. As practice shows, about 20% of all pregnant women face this problem.

In the absence of timely high-quality treatment, women may develop cystitis, pyelonephritis and other pathologies of the genitourinary organs. An increased number of bacteria in the urine causes a general intoxication of the body, which leads to a delay in the development of the fetus, and in some cases provokes premature birth or miscarriage.

Prevention of pathology

To avoid the development of bacteriuria during pregnancy, it is necessary to undergo a routine examination by the attending physician and conduct a complete examination throughout the pregnancy. If a girl has previously been diagnosed with any kind of inflammatory, infectious pathology of the genitourinary organs, it is necessary to be especially careful and take a number of preventive measures, which include:

1. Maintain intimate hygiene with the help of special products (cleansing gel, cream, wipes). Sometimes doctors prescribe special drugs that stimulate the immune system and improve it in order to avoid the active development of bacteria and infection in it.
2. Full compliance with all prescriptions of the attending physician, taking vitamins and multivitamin complexes that stimulate the immune system.
3. Leading a healthy lifestyle.
4. The absence of heavy physical exertion, only general developmental exercises are acceptable.
5. Proper nutrition and fluid intake.

According to statistics, bacteria in urine are found in every fifth pregnant woman. But do not immediately panic, because their presence can be caused by any other physiological changes in the body.

The prognosis of the disease in a pregnant woman

An important role in the prognosis of bacteria is timely identification. If an excess of the norm of microorganisms in urine was detected in the initial stages, then the prognosis is considered favorable. The doctor prescribes effective treatment without the use of radical drugs. This minimizes the threat to the development of the unborn child.

If the exacerbation was diagnosed in the last months of pregnancy, then serious complications can occur during treatment, such as a suspension in the development of the child, miscarriage. In the absence of treatment, the disease becomes dangerous for the mother, serious pathologies of internal organs (, oncology, kidney failure) can occur.

The detection of bacteria in the urine can be observed in three cases: contamination of the material collected for analysis, infection of the urinary system, and the presence of asymptomatic bacteriuria in the patient. It is the latter that we will devote this article to.

According to the definition of the American Society for Infectious Diseases, asymptomatic bacteriuria is the shedding of more than 10x5 (for men, more than 10x3) bacteria per 1 milliliter of urine in individuals who do not have clinical symptoms of a urinary tract infection.

Let's try to explain it easier. If bacteria are found in the patient's urine in excess of the norm, but the person is not disturbed by any symptoms from the urinary system (no pain and burning during urination, no pain in the bladder and kidneys, no leukocytes in the urine and temperature), then this situation is called asymptomatic bacteriuria.

In different countries, the incidence of bacteriuria is 3-25% among the general population. In people who initially have a violation of the urinary system, chronic diseases of the urological tract, as well as congenital anomalies in the structure of the urinary organs, the prevalence of bacteriuria is much higher and can reach up to 40-50%.

Asymptomatic bacteriuria is most commonly seen in the following groups (see Table 1 below).

When is bacteriuria dangerous?

In most cases, asymptomatic excretion of bacteria in the urine does not pose any harm to the human body and rarely leads to negative consequences.

The only exceptions are certain groups of the population, the risk of complications of urological infection in which is much higher than in the general population.

At risk for the development of complications of bacteriuria are:

1. 1 Pregnant women.
2. 2 Persons with a planned surgical intervention on the organs of the urinary system.
3. 3 Persons who have undergone surgery on the organs of the urinary system and kidney transplantation.
4. 4 Patients with a urinary catheter, especially for a long term.
5. 5 Patients with spinal injury.
6. 6 Persons with diabetes mellitus, especially in the stage of decompensation.

However, not all patients in these risk groups need to be screened for bacteriuria and treated. Why?

Dynamic monitoring of these patients made it possible to establish the following points:

1. 1 Screening and treatment of bacteriuria during pregnancy significantly reduces the risk of pyelonephritis.
2. 2 Detection of bacteriuria and its therapy in patients with diabetes mellitus does not reduce the incidence of cystitis and pyelonephritis, however, this approach contributes to the emergence of resistant strains of microorganisms. Therefore, in this case, the approach is justified - "we choose the lesser of two evils."
3. 3 Detection of bacteria in the urine and administration of antibiotic therapy does not improve prognosis or reduce the risk of urological complications in patients with spinal cord injury. Therefore, screening is not justified in this case.
4. 4 In individuals with a long-term urinary catheter, screening for bacteriuria is not needed for the same reason as in patients with diabetes mellitus. If the catheter is installed for a short period (for 2-3 days), then antibiotic therapy for bacteriuria may be justified.

Thus, the identification of asymptomatic bacteriuria and its antibiotic therapy are justified in three main groups:

1. 1 In pregnant women.
2. 2 In persons with a planned operation on the organs of the urinary system.
3. 3 In persons who underwent surgery on the organs of the urinary system and kidney transplantation (in the first months).

1. 1 Non-pregnant premenopausal women;
2. 2 Women with concomitant diabetes mellitus;
3. 3 elderly patients, including those living in nursing homes;
4. 4 Persons with spinal cord injuries;
5. 5 Patients with a permanent urinary catheter;
6. 6 Patients with a functioning nephrostomy;
7. 7 In patients with yeast fungi of the genus Candida in the urine;
8. 8 In kidney transplant patients more than 6 months after transplantation.

2. Bacteria in the urine of pregnant women

The increased interest in the presence of bacteria in the urine during pregnancy is due not only to the prevalence of urinary tract infections, but also to the fact that asymptomatic bacteriuria often causes complications during the period of gestation and infection of the mother-fetus system.

According to the literature, in pregnant women with an infectious process in the urinary system, the birth of children with signs of intrauterine infection is approximately 20-50% more likely.

Asymptomatic bacteriuria during pregnancy is one of the most common forms of urinary tract infection, reaching an incidence of 16.5% (11). Most often, bacteriuria is considered as a risk factor for pyelonephritis.

The main aspects of the negative impact of asymptomatic bacteriuria in pregnant women:

1. 1 During gestation, bacteriuria may progress to a clinically manifest urological disease (often pyelonephritis). Thus, the incidence of pyelonephritis in healthy pregnant women is only 2.8%, while in women with asymptomatic bacteriuria in the absence of treatment, this figure can reach up to 30%. A number of authors claim that the treatment of asymptomatic bacteriuria during early pregnancy in 80% of cases prevents the occurrence of acute pyelonephritis.
2. 2 The presence of a focus of chronic infection, even in the absence of symptoms, often leads to intrauterine infection of the fetus, the threat of abortion, placental attachment disorders, polyhydramnios, and uteroplacental insufficiency.
3. 3 Pregnant women with bacteriuria have a higher rate of miscarriage, miscarriage and low birth weight.
4. 4 In the presence of asymptomatic bacteriuria, the risk of placental pathology is higher, which can be expressed in impaired differentiation of the chorionic villi, thrombosis of the intervillous space, and inflammation of the membranes.
5. 5 The effect of bacteriuria of pregnant women on the fetus is reduced to an increased risk of infection (IUI), an increased risk of intrauterine growth retardation.

2.1. Diagnostic criteria

The proven negative impact of bacteriuria on the body of the mother and fetus makes it important to detect it in a timely manner using the following criteria:

1. 1 Detection of more than 10x5 cfu / ml of bacteria of the same species in two different bacteriological urine cultures administered at least 24 hours (day) apart in pregnant women who do not have signs of urinary tract infection.
2. 2 Single detection of more than 10x5 CFU / ml of pathogenic bacteria during urine collection using a urinary catheter.

The severity of the listed diagnostic criteria is due to the fact that with a single urine culture in pregnant women, contamination with microorganisms from the skin of the perineum is possible in about 35-40% of cases.

To date, the most important criterion for asymptomatic bacteriuria (the presence of bacteria in the urine of more than 10x5 CFU / ml), is criticized as being too stringent for pregnant women, but justified as rational, in connection with the results of studies in which the isolation of bacteria in the urine in a titer of 10x4 led to an increase in pregnancy complications.

In Russia, medical examination of pregnant women with a double urine culture for the presence of bacteriuria is still not carried out due to the relative high cost, however, it is planned to introduce more affordable diagnostic methods and test systems (Display, paper express tests) in the near future.

3. Patient management

The widespread prescription of antibiotics for the treatment of asymptomatic bacteriuria is not justified and can lead to complications such as:

1. 1 Increased incidence of infections involving microorganisms resistant to antibiotic therapy;
2. 2 Development of adverse reactions (including antibiotic-associated diarrhea);
3. 3 Reinfection of the organism by antibiotic-resistant flora;
4. 4 Toxic damage to internal organs.

According to Russian and European urological guidelines, treatment of asymptomatic bacteriuria is recommended ONLY in certain populations, which include:

1. 1 Pregnant women (Ib, recommendation A);
2. 2 Persons with a planned resection (transurethral) of the prostate (Ib, recommendation A);
3. 3 Persons with other planned traumatic urological interventions (IIa, recommendation B);
4. 4 Women with catheter-associated bacteriuria persisting for more than 48 hours (in this case, it is necessary to consider the possibility of prescribing a short course of antibiotic therapy) - IIa, recommendation B).

The choice of drug is made after determining the sensitivity of the pathogen to antibiotics. This study will certainly accompany.

3.1. Features of the treatment of pregnant women

The choice of an antibacterial drug for the treatment of bacteriuria in a pregnant woman directly depends on the degree of its passage through the placenta, which limits the negative impact on the fetus.

Among the antibiotics used in pregnancy, the most commonly used and safe are B-lactams (penicillins, cephalosporins, carbapenems, and monobactams).

It is preferable to use antibiotics with a narrow spectrum of antimicrobial activity, which provides less negative impact on the state of the intestinal microflora, and therefore less often leads to the development of antibiotic-associated diarrhea.

The choice of treatment regimen for the treatment of asymptomatic bacteriuria during pregnancy:

1. 1 The drug of choice is fosfomycin 3 g once (preferably at night). Fosfomycin has a high clinical activity against most uropathogens. Sufficient to ensure the antimicrobial effect, the concentration of the antibiotic in the urine is maintained for 3 days after administration. It has been proven that even a single dose of fosfomycin in asymptomatic bacteriuria is equivalent to a 7-day intake of amoxicillin clavulanate. If the concentration of pathogens is initially high, then it is possible to re-administer the drug after 24 hours. Longer-term use of fosfomycin is not recommended, which limits its use in pyelonephritis;
2. 2 Alternative drugs - amoxicillin clavulanate, cefuroxime axetil, nitrofurantoin. The drugs are administered orally in standard dosages for a course of 7 days.

Modern therapy of bacteriuria in Russia is far from perfect. According to multicenter studies, in 100% of cases, herbal uroseptics are prescribed for pregnant women with bacteriuria. Antibiotics were additionally prescribed only in 14.8% of cases.

This approach to therapy can hardly be called optimal. The main mistakes are:

1. 1 Prescribing medicines with no proven efficacy (dietary supplements, herbal preparations);
2. 2 Prescribing antibiotics with a level of resistance to them in pathogens of urological infections of more than 20%;
3. 3 Prescribing antibiotics that are dangerous for fetal development (eg, fluoroquinolones).

3.2. Asymptomatic bacteriuria in children

This pathology in childhood is extremely rare, mainly among children with congenital anomalies in the development of the urinary tract.

Asymptomatic bacteriuria can be found in 30% of patients on hemodialysis. This is due to a decrease in urine output, which promotes the growth of bacteria.

Bacteria in the urine of a child without symptoms of urological tract infection may be detected by improper collection of material using non-sterile containers (eg, urine from a pot into a non-sterile container).

The main signs of contamination of the test material are:

1. 1 Isolation of more than one type of bacteria in the analysis of urine.
2. 2 Presence of signs of contamination (vaginal epithelial cells, feces, etc.).

If contamination of the material with bacteria from the outside (from the skin of the perineum, non-sterile containers) is suspected, it should be repeated.

More information is required to determine the management of a child with bacteriuria.

The question of the treatment of asymptomatic bacteriuria in children with diabetes mellitus, immunodeficiency, as well as those with planned invasive urological procedures is controversial. In these cases, the issue of antibiotic therapy is decided individually by the attending physician.