Asymptomatic Bacteriuria in A Pregnant Lady

A 21-year-old woman who is 12 weeks pregnant with her first child presents to your office. A urinalysis shows evidence of bacteriuria. She is completely asymptomatic. Appropriate management at this time includes which one of the following?

A) No treatment at this time; repeat urinalysis at her next visit.
B) Reassure the patient that antibiotic administration is not necessary unless she should develops symptoms.
C) No antibiotic treatment; ask the patient to drink more fluids and cranberry juice daily.
D) Discontinue urinalysis at OB visits because of the high rate of false positives.
E) Treat the patient with a 7-day course of amoxicillin.

Answer and Discussion

The answer is E. Treat the patient with a 7-day course of amoxicillin.

Asymptomatic bacteriuria, defined as more than 100,000 colonies of a single bacterial species per milliliter of urine, cultured from midstream sample, is present in 2% to 7% of pregnant women. The most commonly associated bacteria is Escherichia coli. Pregnancy does not increase the incidence of asymptomatic bacteriuria; however, pyelonephritis develops in a significant number of pregnant women with untreated asymptomatic bacteriuria. Asymptomatic bacteriuria in women is associated with a higher preterm delivery rate than women without bacteriuria. Treatment of group B Streptococcus (GBS) bacteriuria has also been shown to decrease the rate of preterm delivery. Additionally, GBS bacteriuria has been associated with heavy GBS genitourinary colonization.
The Centers for Disease Control and Prevention (CDC) recommends that pregnant women with GBS bacteriuria be treated at the time of diagnosis and during labor. Intrapartum antibiotic prophylaxis is used to prevent early GBS infection in newborns.
In most cases, women who do not have asymptomatic bacteriuria at the initial prenatal visit will not develop bacteriuria later in the pregnancy. Accordingly, routine screening for asymptomatic bacteriuria should be performed at the initial prenatal visit.
Treatment options include a 3- to 7-day course of (1) oral amoxicillin, (2) nitrofurantoin (Macrobid), or (3) cephalexin (Keflex).
After therapy is completed, a urine culture should be repeated to ensure eradication of infection. This repeat culture also identifies patients with persistent or recurrent bacteriuria. For patients who have persistent or recurrent bacteriuria, consideration should be given to administering suppressive doses of antibiotics.