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Las infecciones del tracto urinario –bacteriuria asintomática (BA), cistitis aguda (CA) y pielonefritis aguda (PA)– son favorecidas por los cambios morfológicos y funcionales del embarazo. La BA aumenta el riesgo de parto pretérmino, de bajo peso al nacimiento y de PA. Se debe detectar mediante urocultivo (otros métodos no son suficientemente eficaces) y tratar precozmente. Escherichia coli causa alrededor del 80% de los casos. Se deben valorar los riesgos y la eficacia de las distintas pautas antibióticas: la fosfomicina-trometamol en monodosis o pauta corta resulta eficaz y segura para el tratamiento de la BA y la CA. La PA es la razón más frecuente de hospitalización por causa médica en la embarazada y puede complicarse en el 10% de los casos, poniendo en riesgo la vida fetal y la materna. Actualmente se propone el tratamiento ambulatorio de la PA en casos seleccionados. Es necesario un adecuado seguimiento de las gestantes con infección del tracto urinario (ITU) por las frecuentes recurrencias.
Palabras clave:
Infección del tracto urinario
Embarazo
Antibióticos
Bacteriuria asintomática
Pielonefritis aguda
Urinary tract infections, asymptomatic bacteriuria (AB), acute cystitis (AC) and acute pyelonephritis (AP), are favored by the morphological and functional changes involved in pregnancy. AB increases the risk of preterm labor, low birth weight and AP. AB should be detected by uroculture (other methods are not sufficiently effective) and treated early. Approximately 80% of cases are caused by Escherichia coli. The risks and effectiveness of the distinct antibiotic regimens should be evaluated: fosfomycin trometamol in monotherapy or as short course therapy is safe and effective for the treatment of AB and AC. AP is the most frequent cause of hospital admission for medical reasons in pregnant women and can lead to complications in 10% of cases, putting the lives of the mother and fetus at risk. Currently outpatient treatment of AP is recommended in selected cases. Adequate follow-up of pregnant women with urinary tract infections is required due to frequent recurrence.
Key words:
Urinary tract infection
Pregnancy
Antibiotics
Asymptomatic bacteriuria
Acute pyelonephritis
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Bibliografía
[1.]
E.H. Kass.
Asymptomatic infections of the urinary tract.
Trans Assoc Am Physicians, 69 (1956), pp. 56-64
[2.]
L.l. Cabero.
Sociedad Española de Ginecología y Obstetricia (SEGO) Protocolos asistenciales en Obstetricia Infección urinaria y embarazo.
Ediciones Mayo, (2004),
[3.]
B.J. Stoll, N. Hansen, A.A. Fanaroff, L.L. Wright, W.A. Carlo, R.A. Ehrenkranz, et al.
Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants.
N Engl J Med, 347 (2002), pp. 240-247
[4.]
R. Mittendorf, M.A. Williams, E.H. Kass.
Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria.
Clin Infect Dis, 14 (1992), pp. 927-932
[5.]
C. Petersson, S. Hedges, K. Stenqvist, T. Sandberg, H. Connell, C. Svanborg.
Suppressed antibody and interleukin-6 responses to acute pyelonephritis in pregnancy.
Kidney Int, 45 (1994), pp. 571-577
[6.]
B. Nowicki.
Urinary tract Infection in pregnant women: old dogmas and current concepts regarding pathogenesis.
Current Infectious Disease Reports, 4 (2002), pp. 529-535
[7.]
L.C. Gilstrap III, S.M. Ramin.
Urinary tract infections during pregnancy.
Obstet Gynecol Clin North Am, 28 (2001), pp. 581-591
[8.]
Sociedad Española de Ginecología y Obstetricia (SEGO).
Infecciones del tracto urinario en la embarazada.
Ediciones Mayo, (2001),
[9.]
I.R. McFayden, M. Campbell-Brown, M. Stephenson, D.V. Seal.
Single-dose treatment of bacteriuria in pregnancy.
Eur Urol, 13 (1987), pp. S22-S25
[10.]
D.S. Reeves.
Treatment of bacteriuria in pregnancy with single dose fosfomycin trometamol: a review.
Infection, 20 (1992), pp. S313-S316
[11.]
L.E. Nicolle, S. Bradley, R. Colgan, J.C. Rice, A. Schaeffer, T.M. Hooton.
Infectious disease society of American guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
Clin Infect Dis, 40 (2005), pp. 643-654
[12.]
B. Christensen.
Which antibiotics are appropriate for treating bacteriuria in pregnancy?.
J Antimicrob Chemother, 46 (2000), pp. S29-S34
[13.]
P. Bourget, A. Sertin, A. Lesne-Hulin.
Influence of pregnancy on the pharmacokinetics behaviour and the transplacental transfer of the piperacilin-tazobactam combination.
Eur J Obstet Gynecol Reprod Biol, 76 (1998), pp. 21-27
[14.]
ACOG Educational Bulletin.
Antibiotics and gynecologic infections. American College of Obstetricians and Gynecologist.
Int J Gynaecol, 58 (1997), pp. 333-340
[15.]
H. Larsen, G.L. Nielsen, H. Schonheyder, C.H. Olesen, H.T. Sorensen.
Birth outcome following maternal use of fluoroquinolones.
Int J Antimicrob Agents, 18 (2001), pp. 259-262
[16.]
Wogelius P, Norgaard M, Gislum M, Pedersen L, Schoenheyder HC, Sorensen HT. Further analysis of the risk of adverse birth outcome after maternal use of fluoroquinolones. Int J Antimicrob Agents. En prensa, 2005.
[17.]
G.L. Gilbert, S.M. Garland, K.F. Fairley, D.M. McDowal.
Bacteriuria due to ureaplasmas and other fastidious organism during pregnancy: prevalence and significance.
Pediatr Infect Dis, 5 (1986), pp. 633-635
[18.]
F.G. Cunningham, M.J. Lucas.
Urinary tract infection complicating pregnancy.
Bailliere's Clin Obstet Gynaecol, 8 (1994), pp. 353-373
[20.]
H. Leffler, C. Svanborg-Eden.
Glycolipid receptors for uropathogenic Escherichia coli on human erythrocytes and uroepithelial cells.
Infect Immun, 34 (1981), pp. 920-929
[21.]
E. Gratacós, P.J. Torres, J. Vila, P.L. Alonso, V. Cararach.
Screening and treatment of asymptomatic bacteriuria in pregnancy prevent pyelonephritis.
J Infect Dis, 169 (1994), pp. 1390-1392
[22.]
L.K. Millar, S.M. Cox.
Urinary tract infections complicating pregnancy.
Infect Dis Clin North Am, 11 (1997), pp. 13-26
[23.]
R. Mittendorf, M.A. Williams, E.H. Kass.
Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria.
Clin Infect Dis, 14 (1992), pp. 927-932
[24.]
R. Romero, E. Oyarzun, M. Mazor, M. Sirtori, J.C. Habbins, M. Bracken.
Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight.
Obstet Gynecol, 73 (1998), pp. 576-580
[25.]
V.T. Andriole, T.F. Patterson.
Epidemiology, natural history and management of urinary tract infections in pregnancy.
Med Clin North Am, 75 (1991), pp. 359-373
[26.]
Z. Hagay, R. Levy, A. Miskin, D. Milman, H. Sharabi, V. Insler.
Uriscreen, a rapid enzymatic urine screening test: useful predictor of significant bacteriuria in pregnancy.
Obstet Gynecol, 87 (1996), pp. 410-413
[27.]
L. Millar, L. Debuque, C. Leialoha, A. Grandinetti, J. Killeen.
Rapid urine screening test to detect bacteriuria in pregnancy.
Obstet Gynecol, 95 (2000), pp. 601-604
[28.]
R.J. Teppa, J.M. Roberts.
The uriscreen test to detect significant asymptomatic bacteriuria during pregnancy.
J Soc Gynecol Investig, 12 (2005), pp. 50-53
[29.]
A.W. Robertson, P. Duff.
The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients.
Obstet Gynecol, 71 (1988), pp. 878-881
[30.]
L.L. Keeler Jr.
Tests to detect asymptomatic bacteriuria tract infections.
JAMA, 271 (1994), pp. 1399-1400
[31.]
S.D. Shelton, K.A. Boggess, K. Kirvan, F. Sedor, W.N. Herbert.
Urinary interleukin-8 with asymptomatic bacteriuria in pregnancy.
Obstet Gynecol, 97 (2001), pp. 583-586
[32.]
J.W. Bachman, R.H. Heise, J.M. Naessens, M.G. Timmerman.
A study of various tests to detect asymptomatic urinary tract infections in an obstetric population.
JAMA, 270 (1993), pp. 1971-1974
[33.]
R.D. McNair, S.R. MacDonald, S.L. Dooley, L.R. Peterson.
Evaluation of the centrifuged and Gram-stained smear, urinalysis, and reagent strip testing to detect asymptomatic bacteriuria in obstetric patients.
Am J Obstet Gynecol, 182 (2000), pp. 1076-1079
[34.]
C. Chongsomchai, E. Piansriwatchara, P. Lumbiganon, K. Pianthaweechai.
Screening for asymptomatic bacteriuria in pregnant women: urinalysis versus urine culture.
J Med Assoc Thai, 82 (1999), pp. 369-373
[35.]
Smaill F. Antibiotics for asymptomatic bacteriuria in pregnancy. The Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No. CD000490. DOI: 10.1002/14651858.CD000490.
[36.]
I.R. McFayden, M. Campbell-Brown, M. Stephenson, D.V. Seal.
Single-dose treatment of bacteriuria in pregnancy.
Eur Urol, 13 (1987), pp. S22-S25
[37.]
M. Garau, A. Latorre, M. Alonso-Sanz.
Fosfomicina: un antibiótico infravalorado en infecciones urinarias por Escherichia coli.
Enferm Infecc Microbiol Clin, 19 (2001), pp. 462-466
[38.]
B. Lobel.
Short term therapy for uncomplicated urinary tract infection today. Clinical outcome upholds the theories.
Int J Antimicrob Agents, 22 (2003), pp. S85-S87
[39.]
Villar J, Widmer M, Lydon-Rochelle MT, Gülmezoglu AM, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. The Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No. CD000491. DOI: 10.1002/14651858.CD000491.
[40.]
F.G. Cunningham, M.J. Lucas.
Urinary tract infections complicating pregnancy.
Baillieres Clin Obstet Gynaecol, 8 (1994), pp. 353-373
[41.]
R.E. Harris, L.C. Gilstrap III.
Cystitis during pregnancy: A distinct clinical entity.
Obstet Gynecol, 57 (1981), pp. 578
[42.]
M.L. Cañete Palomo, E. Buendía.
Infección urinaria y uropatía obstructiva du ran te la gestación.
Fundación para la Investigación Sanitaria en Castilla-La Mancha Urgencias en ginecología y obstetricia, FISCAM, (2003),
[43.]
F.G. Cunningham, N.F. Gant, K.J. Leveno, et al.
Enfermedades renales y de las vías urinarias. Williams Obstetricia.
21.ª ed., Editorial Médica Panamericana, (2003),
[44.]
S. Kremery, J. Hromec, D. Demesova.
Treatment of lower urinary tract infectionin pregnancy.
Int J Antimicrob Agents, 17 (2001), pp. 279-282
[45.]
J.B. Hill, J.S. Sheffield, D.D. McIntire, G.D. Wendel Jr.
Acute pyelonephritis in pregnancy.
Obstet Gynecol, 105 (2005), pp. 18-23
[46.]
J.C. Graham, J.BS. Leathart, S.J. Keegan, et al.
Analysis of Escherichia coli strains causing bacteriuria during pregnancy: selection for strains that do not express type 1 fimbriae.
Infect Immun, 69 (2001), pp. 794-799
[47.]
M.R. Cavenee, S.M. Cox, R. Mason, F.G. Cunningham.
Erythropoietin in pregnancies complicated by pyelonephritis.
Obstet Gynecol, 84 (1994), pp. 252-254
[48.]
F.G. Cunningham, M.J. Lucas, G.D. Hankins.
Pulmonary injury complicating antepartum pyelonephritis.
Am J Obstet Gynecol, 156 (1987), pp. 797-807
[49.]
S.M. Cox, P. Shelburne, R. Mason, S. Guss, F.G. Cunningham.
Mechanisms of hemolysis and anemia associated with acute antepartum pyelonephritis.
Am J Obstet Gynecol, 164 (1991), pp. 587-590
[50.]
D.A. Wing, A.S. Park, L. DeBuque, et al.
Limited clinical utility of blood and urine cultures in the treatment of acute pyelonephritis during pregnancy.
Am J Obstet Gynecol, 182 (2000), pp. 1437-1441
[51.]
S.K. Hendrick, S.O. Ross, J.N. Krieger.
An algoritm for diagnosis and therapy of management of complications of urolithiasis during pregnancy.
Surg Obstet Gynecol, 172 (1991), pp. 49-54
[52.]
Wing DA. Pielonefritis. Clin Obst Ginecol (ed. esp.). 1998;3:481-91.
[53.]
D.A. Wing, C.M. Hendershott, L. Debuque, L.K. Millar.
Outpatient treatment of acu te pyelonephritis in pregnancy after 24 weeks.
Obstet Gynecol, 94 (1999), pp. 683-688
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