Primary Care Management of Urinary Tract Infection in Pregnant Women Dr. Charlotte Cooke ([email protected]) Northumbria Healthcare NHS Foundation Trust Background •Symptomatic bacteriuria occurs in 17-20% of pregnancies.1 There are pathophysiological grounds to support a link between pre-labour premature rupture of membranes and pre-term labour. Results •4 UTI’s were discovered upon screening and 43 were clinically suspected. •100% of women were screened with a urine culture at their 1st antenatal appointment. •100% of women with a suspected UTI had a urine culture sent. •Untreated upper urinary tract infection (UTI), in pregnancy also carries well documented risks of morbidity, and rarely, mortality to the pregnant woman.2 •Antibiotic treatment of asymptomatic bacteriuria in pregnancy reduces the risk of upper urinary tract infection, pre-term delivery and low birth weight babies.3 Aims •To identify whether the management of UTI in pregnant women, is in keeping with national guidance, (Scottish Intercollegiate Guidance Network (SIGN)) within a General Practice setting. Method •Retrospective audit, collecting data using the Egton Medical Information Systems (EMIS), over a 1 year period. • The audit compared standard guidelines with the management of 31 pregnant women. Standards/ Guidance •27 positive urine cultures in total. •19% of women with a proven UTI had a urine culture sent, 1 week post antibiotics. •0% were followed up with monthly urine cultures. SIGN advised the following management.4 Appropriate investigations should be carried out: Conclusion •A urine culture should be performed routinely at first antenatal visit. •Guidelines were met on investigation, with 100% of cultures sent for ante- •For pregnant women with a suspected UTI a single urine culture should be natal screening and symptomatic women. taken. •Areas identified for improvement included: the prescription of antibiotics and follow up management. Appropriate treatment should be prescribed: •A seven day course of antibiotics should be given empirically in suspected UTI Recommendations or therapeutically in proven UTI. •A new service should be implemented to ensure follow up of pregnant •First line antibiotics include; amoxicillin, cefalexin and nitrofurantoin. women with a proven UTI. •Trimethoprim should be avoided, particularly in folate deficient women. •Upon diagnosis, patients should be advised to hand in a urine culture, 1 week post antibiotic therapy, and on a monthly basis thereafter until full term. For women with a proven UTI, routine follow up should include: Doctors should chase results and midwives track progress at each antenatal •A urine culture 7 days post antibiotic treatment. appointment. •Monthly urine cultures throughout pregnancy. •Once firmly established a re-audit should be performed in 6-12 months time. References 1) 2) 3) 4) Vazquez JC, Villar J. Treatments for symptomatic urinary tract infections during pregnancy (Cochrane Review). In: The Cochrane Library, Issue 3 2000. Chichester, UK: John Wiley and Sons Ltd. National Institute for Health and Clinical Excellence. Antenatal Care: routine care for the healthy pregnant women. London: NICE; 2003. (Clinical Guideline 6) Smaill F. Antibiotics for asymptomatic bacteriuria in pregnancy (Cochrane Review). In: The Cochrane Library, Issue 2 2002. Chichester, UK: John Wiley and Sons Ltd. SCOTTISH INTERCOLLEGIATE GUIDELINES NETWORK (2006). Management of Suspected Bacterial Urinary Tract Infection in Adults. Edinburgh: SIGN.