Bacteriuria during pregnancy affects the fetus. Asymptomatic bacteriuria in pregnant women (Asymptomatic bacteriuria in pregnant women, Latent chronic bacteriuria in pregnant women). Methods for diagnosing bacteriuria

The asymptomatic presence of bacteria in the urine in a titer of more than 10 to 5 per 1 ml in at least 2 samples, without clinical manifestations, in a pregnant woman alarms gynecologists, urologists, and general practitioners.

Bacteriuria is one of the risk factors for the development of gestational pyelonephritis in 1/3 of cases.

The appearance of bacteria in urine is quite common, but some doctors still argue about the need for antibacterial therapy in the absence of clinical manifestations.

Etiological factor

The main pathogen is Escherichia coli. According to some data, the frequency of its inoculation in urine is up to 95%; pathogens from the Enterobacter family, staphylococcal and streptococcal flora are less common.

Pathogenesis of asymptomatic bacteriuria, or why bacteria appear in urine during pregnancy

Pregnancy is not believed to increase the incidence of bacteriuria. The likelihood of developing pyelonephritis in pregnant women with bacteria in the urine occurs due to changes in the urinary tract: expansion of the internal cavities of the kidneys and insufficiency of the bladder sphincter.
In 1/5 of pregnant women, bacteria appear in the urine against the background of periodically worsening vaginal candidiasis.

Long-term latent persistence of pathogenic microflora in the urogenital tract of a pregnant woman can be complicated by chorioamnionitis, which sometimes results in intrauterine fetal death, purulent-septic complications, and premature development of labor.

Risk factors

In the development of risk factors, great importance is given to the action of progesterone and the enlargement of the pregnant uterus.

As a result, the following changes occur:

Slowing the flow of urine
expansion of the internal cavities of the kidneys,
decreased tone of the urinary tract,
development of vesicoureteral reflux,
change in urine pH,
increase in estrogen and glucose.

Since the presence of bacteria in urine is a microbiological sign, there is no clinic.

Diagnostic measures

As a rule, bacteria inhabit a woman’s urethra even before pregnancy. According to statistics, in the 3rd trimester, bacteriuria appears in only 1% of cases.

The diagnosis is confirmed by urine culture for flora.

Additionally, urine is examined according to Nechiporenko.

Ultrasound of the kidneys does not find any pathology.

It should be remembered that bacteria in urine may be present due to contamination of biomaterial samples, this is especially true if microorganisms atypical for the urogenital tract are found.

Thrush that exists before pregnancy or develops due to hormonal changes will make the test false positive.

There is no ICD code for asymptomatic bacteriuria.

How to get rid of bacteria in a pregnant woman's urine

All pregnant women who have twice received growth of pathogenic microflora in culture need treatment.

Timely prescribed antibacterial treatment reduces the likelihood of purulent gestational pyelonephritis, intrauterine growth retardation and premature onset of labor.

Prescribing an antibiotic without assessing the sensitivity of the microbe to the drug is not recommended. If bacteria appear in the urine after catheterization of the bladder, a single dose of an antibacterial drug is possible.

Pregnant women with asymptomatic bacteriuria are prescribed the following medications:

Amoxiclav in combination with clavulanic acid 375 - 625 mg 2-3 times a day for 5-7 days
Amoxicillin 250 - 500 mg 3 times a day - 7 days
Cefixime 400 mg once a day for 7 days
Cephalexin 250 - 500 mg 4 times a day for 7 days Fosfomycin 3 mg once.

To prevent dyspeptic disorders that appear due to the massive death of gram-negative bacteria, the treatment regimen includes Enterosgel a large tablespoon 3 times a day for 7 days.

Phytotherapy

Considering that pregnancy is a condition when allergic reactions to anything are possible, you should not choose any multicomponent collection for the treatment of bacteriuria.

A decoction of dill seeds, 1/2 cup of decoction 3 times a day, for a course of 10 days, helps well. Hypersensitivity to dill seeds is rare; newborns are prescribed dill water from the first days of life to relieve intestinal colic.

To improve the passage of urine, there are special gymnastics for the kidneys. To do this, the woman stands in a knee-elbow position (on her knees and elbows) and is in this position several times a day for 5-10 minutes.

Regular consumption of cranberry juice acidifies the urine, resulting in an antimicrobial effect.

Bacteria in the urine of pregnant women are detected quite often, but timely treatment prevents the development of pyelonephritis by 80%, and contributes to the normal prolongation of pregnancy in 5-10% of cases.

After normalization of laboratory parameters, there are no contraindications for independent delivery based on urological status.

This is a laboratory-determined pathological condition during gestation, in which repeated urine testing with a break of 24 hours or more allows the same microorganism to be detected in tests in a titer of 100,000 CFU/ml. There are no clinical symptoms. The disorder is diagnosed using a general urine test, bacteriological culture, and a screening photocolorimetric TTX test. Treatment is carried out using fosfomycins, semi-synthetic penicillins, cephalosporins, synthetic nitrofurans, and herbal uroantiseptics.

ICD-10

O23 Urinary tract infection during pregnancy

General information

Asymptomatic bacteriuria (ASB, asymptomatic or latent chronic bacteriuria) is detected in 2.5-26% of pregnant women. In patients with low socioeconomic status, the syndrome develops 5 times more often. Often, non-inflammatory bacterial colonization of the urinary tract precedes gestation. In 52.3% of pregnant women, asymptomatic bacteriuria is detected in the first trimester, in 35.4% in the second, and in 12.3% in the third. According to WHO recommendations, an increase in the content of bacterial agents to 100 thousand or more CFU/ml is clinically significant. However, according to the observations of specialists in the field of urology, obstetrics and gynecology, the risk of complicated gestation occurs even with titers from 100 to 10,000 CFU/ml.

Causes

The pathology is caused by commensal microorganisms that normally colonize the periurethral and perianal areas. In 95% of patients, a monoinfection is detected. In almost 2/3 of cases, etiopathogens are gram-negative: in 51.7% of pregnant women with asymptomatic bacteriuria, E. coli is detected in tests; Proteus, Klebsiella, Enterobacter, Citrobacter, pseudomonas, and non-fermenting bacteria are less common. Gram-positive microflora is represented by staphylococci (epidermal, hemolytic, saprophytic), pyogenic streptococcus, fecal enterococcus.

The risk of developing a pathological condition increases in women with bacterial vaginosis, previous urogenital infections, congenital anomalies of the urinary organs, a history of nephrolithiasis, long-term smoking, diabetes mellitus, frequent sore throats and acute respiratory infections. Specific factors contributing to the development of latent chronic bacteriuria in the gestational period are characteristic metabolic, urodynamic changes and mechanical effects:

• Stagnation and backflow of urine. In pregnant women, expansion of the collecting system, hypotension of the ureters and bladder, and relaxation of the urethral sphincter are observed, caused by the reaction of smooth muscle fibers to an increase in the concentration of progesterone. Some patients experience vesicoureteral and ureteropelvic reflux. The situation is aggravated by a 1.5-fold acceleration of glomerular filtration and mechanical compression of the urinary organs by the enlarged uterus.
• Changes in the chemical composition of urine. The influence of counter-insular hormones (cortisol, placental lactogen, human chorionic gonadotropin) contributes to the development of physiological insulin resistance in pregnant women. In combination with increased synthesis of glucose by the liver, this leads to the development of transient glucosuria, and if compensatory mechanisms are insufficient, gestational diabetes. Glucose serves as a suitable substrate for the nutrition and growth of microorganisms that enter the urothelium.
• Decreased immunity. Restructuring the pregnant woman’s immune system is aimed at preserving gestation. To prevent rejection of a genetically alien fetus, the activity of T-suppressors in a woman’s body doubles, T-killers, phagocytic blood neutrophils, and macrophages are inhibited, and the concentration of immunoglobulin G decreases. As a result, the patient’s susceptibility to bacterial infection increases, which contributes to the asymptomatic activation of commensals.

Pathogenesis

The mechanism of development of asymptomatic bacteriuria in pregnant women is based on the ascending spread of commensal microorganisms along the urinary tract. It is extremely rare that infection occurs through the hematogenous route. Typically, etiopathogens that persist on the mucous membranes of the periurethral zone enter the urinary system through a relaxed urethral sphincter. An insufficient immune response does not ensure complete elimination of bacteria, the concentration of which is insufficient to cause a classic inflammatory response. Due to the presence of adhesins, hemolysin and other virulence factors, infectious agents colonize the urothelium. Accelerated bacterial growth is facilitated by a physiological increase in urine pH and possible glycosuria.

Complications

Clinically hidden bacteriuria does not manifest itself in any way, however, even with a low titer of microorganisms (100-10,000 CFU/ml), a complicated course of pregnancy is significantly more often observed. In 20-40% of cases, against the background of asymptomatic bacteriuria, pregnant women develop acute gestational pyelonephritis. Increased local and systemic synthesis of prostaglandins, which are myometrial stimulants, provokes premature birth. The risk of gestosis, anemia of pregnant women, fetoplacental insufficiency, intrauterine fetal hypoxia, delayed fetal development, and infectious complications (chorioamnionitis, postpartum endometritis) increases. Indicators of prematurity and neonatal mortality in BBU increase by 2-2.9 times. It is significant that treatment of timely diagnosed asymptomatic bacteriuria significantly reduces the likelihood of complications.

Diagnostics

The difficulty of identifying the syndrome is due to the lack of symptoms and pathognomonic complaints. Asymptomatic bacteriuria in pregnant women is diagnosed laboratory. Diagnostic alertness is caused by accompanying disorders - increased frequency of urination due to possible transient or permanent glycosuria, vaginal discharge, pain, burning, pain, discomfort in the external genitalia, indicating a probable infectious-inflammatory process.

Taking into account the risk of complications, microbiological screening is recommended for all pregnant women upon registration at the antenatal clinic. The diagnosis of asymptomatic urinary infection is established only in cases where, when bacteria are detected in the urine, there are no clinical, laboratory and instrumental signs of infectious and inflammatory diseases of the urinary organs. The examination plan usually includes:

• General urine analysis. To exclude accidental contamination, an average portion of morning urine is examined. The analysis reveals bacteria, and in some pregnant women, leukocytes. Increased pH and glucose in the urine may also be detected.
• Urine culture for microflora. The analysis is performed twice with an interval of at least 24 hours between studies. The diagnosis of bacteriuria is made when the same bacterium is repeatedly detected at a concentration of 100 thousand CFU/ml.
• TTX test. The photocolorimetric screening diagnostic method allows you to detect increased levels of bacteria in the sample within 4 hours. The sensitivity of the reaction with triphenyltetrazolium chloride reaches 90%.

To exclude inflammatory urological diseases and assess the functional capabilities of the kidneys, urine analysis according to Nechiporenko, kidney tests (nephrological complex), general and biochemical blood tests, ultrasound of the kidneys, ultrasound of the renal vessels are recommended as additional studies. X-ray or endoscopic methods are used only in complex diagnostic cases, taking into account possible negative consequences for the woman or fetus. True asymptomatic urinary infection is differentiated from false bacteriuria due to contamination of the material, pyelonephritis, cystitis, urethritis. In addition to the obstetrician-gynecologist, the patient is examined by a therapist, urologist, and nephrologist.

Treatment of bacteriuria in pregnant women

Detection of microorganisms in urine during pregnancy, even in the absence of clinical symptoms and other signs of inflammation, serves as sufficient grounds for prescribing antibacterial therapy. Treatment is usually carried out on an outpatient basis with an empirical choice of one of the recommended regimens. Pregnant women may be prescribed:

• One day course. A single dose of a broad-spectrum antibiotic from the fosfomycin group eliminates most of the bacteria that colonize the urinary tract. Due to its ease of use, high efficiency, and safety, the method is considered preferable for pregnant women.
• Three day course. Semi-synthetic β-lactam penicillins and cephalosporins of the II-III generation are used as an antibacterial single drug. In the 1st-2nd trimester it is permissible to prescribe synthetic nitrofurans; in the 3rd trimester they can provoke hemolytic disease of the newborn.

14 days after the end of the course of taking the antibiotic, a repeat bacteriological examination of the urine is performed. If bacteriuria is absent, dynamic monitoring of the pregnant woman continues. To consolidate the therapeutic effect, non-drug methods are used: increasing urination by drinking plenty of fluids, lowering pH by drinking acidic drinks (cranberry juice, etc.). If factors are identified that increase the risk of developing asymptomatic urinary infection, herbal medicine using complex herbal antiseptics is indicated. If latent bacteriuria is detected again, another antibacterial regimen or drug is prescribed, selected taking into account the sensitivity of microorganisms. The preferred method of delivery for pregnant women who have had BBU is vaginal birth. Caesarean section is performed only if there are obstetric or extragenital indications.

Prognosis and prevention

The effectiveness of short antibacterial courses in the treatment of asymptomatic bacteriuria reaches 79-90%. The prognosis of pregnancy and childbirth with timely detection and adequate treatment of the syndrome is favorable: in 70-80% of pregnant women with signs of PBU, it is possible to prevent the development of pyelonephritis, in 5-10% - prematurity of the child. Primary prevention of asymptomatic urinary infection is aimed at eliminating factors contributing to the occurrence of bacteriuria: preconceptional sanitation of the urogenital organs, smoking cessation, weight correction to reduce the likelihood of developing insulin resistance, drinking fruit drinks to acidify urine, preventive use of urogenital antiseptics by pregnant women at risk.

A healthy person, including expectant mothers, produces sterile urine. But as a result of kidney and urinary tract diseases, bacteria can enter the bladder and quickly spread there. If suddenly an examination of urine under a microscope shows abnormalities and microbes are detected, this indicates the presence of bacteriuria in the pregnant woman. What this disease threatens, what the symptoms are, how to treat it - you will find out further in the article.

Features and types of pathology

Bacteriuria during pregnancy is detected due to the entry of microbes through the kidney filter affected by pathogens. The limit of urine contamination is considered to be 105 bacterial colonies in 1 ml. Cases of exceeding this indicator indicate the occurrence of bacteriuria in pregnant women. Where does microbial flora come from? It can be released through the urinary tract or from the reproductive organs.

Painful microflora arises from the normal environment, which changes in the body of the expectant mother due to the activation of enterobacteria or staphylococci. Doctors choose their tactics depending on where the microbes appeared - in the lower urinary tract or in the upper. In the first case we are talking about urethritis and cystitis, and in the second - about pyelonephritis. Sometimes this is a consequence of catheterization, stone crushing, or cystoscopy.

The causative agents of bacteruria during pregnancy can be streptococci, staphylococci, Escherichia coli, Pseudomonas aeruginosa. There are often cases when bacteriuria during pregnancy is asymptomatic. To identify it, a special study is carried out - screening. In this regard, two types of disease are distinguished: asymptomatic bacteruria and bactereuria accompanied by symptoms. To make an accurate diagnosis, a urine test is performed twice per day.

Characteristic features of asymptomatic bacteriuria in expectant mothers

This type of disease is detected only by urine collection; it has no other manifestations. Pregnant women with an asymptomatic course of the disease feel well and are not aware of impending problems. This suggests that during pregnancy it is very important to undergo all examinations on time. Cases of asymptomatic bacteriuria occur in 10% of pregnant women. Most often, its occurrence is associated with the negative socio-economic environment in which a woman lives.

Some pregnant women with this problem suffer from chronic pyelonephritis, some have vesicoureteral reflux, dilation in the ureters, and the formation of kidney stones. Bacteriuria that occurs during pregnancy leads to the formation of pyelonephritis, and therefore it urgently needs to be treated. Untreated disease leads to the birth of an underweight child or premature birth.

What causes the disease

The urinary system should not contain bacteria that are found on the skin, mucous membranes or in the intestines. The development of microbial flora during pregnancy is influenced by the following factors:

Manifestation of bacteriuria

Sometimes this disease has no special manifestations. It happens that the expectant mother does not suspect anything about the development of microbial flora in the urinary system. Advanced cases lead to the manifestation of the following symptoms of bacteriuria during pregnancy:

• uncomfortable and burning sensation during urination, sometimes accompanied by pain;
• pain in the lower or lateral areas of the abdomen;
• inability to hold urine;
• false calls to its emission;
• elevated temperature;
• weakening of the body, poor health;
• cloudiness of the urine, the appearance of sediment in it.

Study of the disease in expectant mothers

It is known that taking antibiotics is undesirable for pregnant women, so modern diagnostics must accurately determine whether a pregnant woman needs such therapy. To do this, you need to accurately determine the factors that caused the bacteria to enter the genitourinary tract. These may include kidney disease, diabetes, heart failure, abnormal location of the bladder, urolithiasis and others, they were already mentioned above in the article.

An experienced doctor will very quickly detect microbes in the urine, even based on the patient’s complaints. Asymptomatic bacteriuria is a little more complicated. Here you already need a detailed urine analysis. Sometimes only a general analysis is sufficient, but in difficult cases the sterility of urine is checked by culture. Screening is carried out using a test using the TTX reagent. The number of bacteria in the analysis is more than 105 per 1 ml of urine indicates an infected microflora. After a few days, a repeat analysis must be performed. In addition to this analysis, the specialist prescribes a full examination:

• blood test (complete and chemical);
• urine analysis for biochemistry;
• urine examination according to Nechiporenko.

To make an even more accurate diagnosis, an ultrasound examination of the kidneys and their vessels is prescribed.

Therapy

Therapeutic measures for bacteriuria (bacteria are often found in urine during pregnancy) should be started as soon as possible. If treatment for bacteriuria is started in time, many complications in the well-being of the woman and fetus can be avoided. First, the type of pathology is determined: symptomatic or asymptomatic.

Asymptomatic implies the use of safe natural remedies that the patient can take throughout the entire period of pregnancy. You can start with kidney preparations, taking them in the form of tea. Excellent natural preparations are “Cyston”, “Canephron”, “Uralit U”, “Uro-gran”, “Fitolysin”. In addition to these drugs, antimicrobial medications such as uroseptics, antibiotics, penicillins, and cephalosporins are also prescribed. An excellent drug is Monural.

After taking the medication for six months, the bacterial culture is repeated. If no infections are detected, then some herbal preparation is prescribed, and if bacteria are detected again, then other antibiotics are chosen.

Antibiotics can be prescribed to expectant mothers from the 14th to 16th week of pregnancy, when the fetus is already largely formed. In later stages, the fetus is no longer so vulnerable because the placenta protects it. There is no need to be afraid of antibiotic therapy; it is relatively safe and is selected individually.

Disease Prevention

Expectant mothers need to constantly remember to prevent this disease. First, you need to register with the antenatal clinic on time. They will definitely do clinical and biochemical tests of urine and blood. Such analyzes will be carried out regularly. If necessary, a specialist may prescribe an ultrasound of the kidneys. For prevention purposes, antimicrobial agents may be prescribed to reduce the risk of developing pyelonephritis and premature birth.

What is the effect of bacteriuria during pregnancy on the fetus?

The location of the kidneys and urinary system is very close to the uterus, so you should beware of harmful bacteria entering the area of ​​the uterus, the fetal surface layer and the fetus itself. This can lead to infections and inflammation inside the uterus. In this regard, the following complications may arise:

• threat of premature birth;
• the likelihood of having premature babies whose weight does not exceed 2.5 kg;
• danger of premature separation of the membranes of the fetus.

That is why it is very important to regularly send expectant mothers for urine testing in order to promptly identify microbes and the inflammatory processes caused by them. Timely prevention of the disease will allow you to carry your baby to term and give birth without complications.

Diet for bacteriuria during pregnancy and unloading exercises

If bacteriuria is detected, a special drinking regime is recommended. In 24 hours, the patient should drink 2 liters of water in addition to all other liquids. It is very important to take clean water, cranberry or lingonberry juice, and rosehip decoction.

A very important point is special dietary nutrition. It is important to avoid salty, spicy, fried and fatty foods. During this period, you should not take medications with calcium, because this can contribute to the formation of stones and sand in the kidneys. Dietary food should consist of vegetables, fiber, and coarse fibers. During this period, it is better to cook, stew, bake or steam dishes. High-quality raw materials and good composition are available in products in special stores for expectant mothers.

Gymnastics and unloading exercises will increase the outflow of urine from the kidneys and ureters. Such activities can be performed several times a day. They are performed as follows:

• The woman kneels, bends over and leans on her elbows. She stays in this position for about 10 minutes. The procedure is repeated several times a day.
• It is better to sleep on your side so as not to put pressure on the ureters and kidneys with the uterus.
• Do not overfill your bladder and regularly monitor its emptying.

Bacteria in the urine during pregnancy is a very alarming symptom, indicating the likely onset of an inflammatory process in the organs of the genitourinary system. We will talk about the reasons for this phenomenon, about the characteristic symptoms, the appearance of which should cause alarm in the expectant mother, about the essence of the laboratory tests being carried out and about the methods of treating bacteriuria.

Why do pregnant women have their urine tested so often?

Urinalysis is one of the most important and objective indicators of a pregnant woman’s health. It is with its help that doctors are able to timely detect the onset of development of pathological processes in the genitourinary system of the expectant mother long before the appearance of the first clinical symptoms of the disease (and even in their complete absence).

The urine of a healthy person, which is formed in the kidneys and is sterile, does not contain any pathogenic microflora. If the number of bacteria found as a result of a laboratory urine test is insignificant, this is not evidence of pathology. Microorganisms could enter it as they pass through the urethra (urethra).

A high content of pathogenic microorganisms (staphylococci, streptococci, Klebsiella, fecal enterococci, enterobacters) in the urine of the expectant mother, called bacteriuria of pregnant women, may be due to the onset of an inflammatory disease of the genitourinary organs. The most common ailments caused by them are: urethritis, etc. A monthly laboratory test of urine helps not to miss a malfunction of the genitourinary system.

Causes of bacteria in urine

Bacteria in the urine of expectant mothers can appear due to a number of reasons:

• Most often this occurs due to stagnation of urine in the bladder. The reason for this is the physiological processes occurring in the body of a pregnant woman. The continuous growth of the uterus puts pressure on the kidneys and ureters, making it difficult for them to function and to empty the bladder. This clinical picture is typical for the last trimester of pregnancy, when the uterus has already reached an impressive size.
• The cause of bacteriuria in early pregnancy can be hormonal changes in the mother's body. Due to the high content, the tone and peristalsis of the organs of the excretory system (primarily the bladder and ureters) are significantly reduced. Reduced tone of the ureters leads to a slower rate of urine excretion (passage), and the bladder leads to an increase in the amount of urine stagnant in it. Stagnant urine, which often changes its physical and chemical characteristics during pregnancy, is an excellent breeding ground for the development of different types of pathogenic bacteria.
• Bacteria in the urine of a pregnant woman may be due to her failure to comply with basic hygiene rules. Pathogenic microorganisms accumulated on a woman’s external genitalia easily penetrate the urinary canal, giving rise to the process of ascending infection. It is quite easy to prevent it if you perform intimate toilet regularly and correctly (the stream of water washing the genitals should be directed from front to back). Another preventive factor is the frequent change of underwear made from natural materials that allow the skin to “breathe.”
• The cause of bacteriuria may be sexual promiscuity. Intimate intimacy of a pregnant woman with a casual sexual partner can lead to infection of her body not only with pathogens of sexually transmitted diseases, but also with E. coli - the most common culprit of bad urine tests.
• Another channel for the penetration of bacteria into the urine of the expectant mother can be a chronic infection dormant in her body (long-standing caries, untreated diseases of the genitourinary organs, furunculosis). A significant weakening of the immune system that occurs during pregnancy leads to the rapid proliferation of pathogenic microflora.
• Bacteria are often found in the urine of pregnant women with diabetes.

What is the danger of bacteriuria?

The greatest danger to the proper course of pregnancy and even the life of the gestating fetus is asymptomatic bacteriuria, which occurs without any external signs. If not detected in a timely manner, it can lead to:

• to the birth of a child with low birth weight;
• to termination of pregnancy due to the development of placental insufficiency.

Bacteriuria, which is an indispensable companion to pyelonephritis, can lead to spontaneous miscarriage, premature birth or stillbirth.

Symptoms of bacteria in urine

A woman carrying a child should be concerned and contact a specialist managing her pregnancy if:

• During urination, she experiences pain or a strong burning sensation.
• She feels the need to empty her bladder frequently, accompanied by little urine output.
• She was faced with the problem of spontaneous urine leakage.
• She experienced pain in the lumbar region, perineum, lower abdomen, kidneys and bladder.
• Pus is released from the urethra (urethra).
• Her cloudy urine gives off an unpleasant odor and produces sediment.
• Some admixture of blood and inclusions of pus are noticeable in the urine.
• She has been experiencing an increase in body temperature at the subfebrile level for one to two weeks.

Bacteriuria is often accompanied by nausea, sudden urge to vomit and severe physical weakness.

Diagnostics

The main method for detecting bacteriuria in pregnant women is laboratory testing of their urine. Performed monthly, it is performed through rapid diagnosis and urine culture.

Express diagnostics of urine

Carried out using:

• TTX test. This technique is based on the ability of bacteria to give colorless tetrazolium crystals a blue color.
• Reduction glucose test. This study, related to rapid rapid diagnostic methods, is based on the ability of pathogenic microflora to reduce (absorb) small amounts of glucose. When testing a portion of morning urine, the laboratory technician puts a paper strip with a reagent into it, which shows whether there is glucose in this urine sample. If the glucose level does not reach the standard, it is believed that it has been absorbed by bacteria. This test does not belong to the category of studies that give 100% results. It is used only for initial diagnosis.
• Griess nitrite test. The essence of this method is the use of a complex of so-called Griess reagents, which detect the presence of nitrites in the urine. Their presence indicates that pathogenic bacteria contained in the urine of a pregnant woman interacted with nitrates, transforming them into nitrites.

Urine culture

A more reliable and reliable way to detect bacteriuria is urine culture.

• Culture of urine for bacteriuria, during which the laboratory assistant calculates the rate of bacterial reproduction, is the most informative. The main disadvantage of this method is the length of the process (the analysis is performed within forty-eight hours).
• A more simplified method is sowing performed using the Gould method. The test urine sample is placed in a Petri dish consisting of four sections and containing a nutrient substrate made of agar. To transfer the sample to the next sector, a sterile platinum loop is used each time. After a day (this is exactly the time enough for the incubation of pathogenic microflora at a temperature of thirty-seven degrees), using a special table, the number of microorganisms is counted.
• Another option for accelerated inoculation is that glass plates coated with a nutrient substrate are first immersed in the urine sample being tested, and then immediately transferred to special containers. The incubation time of bacteria is no more than sixteen hours. By comparing the results of the analysis with the data of the normative scale, the degree of bacteriuria is determined. The reliability of this test is 95%.

An adequately selected method of urine examination allows not only to determine the true culprit of infection of the genitourinary system of a pregnant woman, but also its sensitivity to drugs, which is necessary for choosing the only correct treatment tactics.

Additional diagnostic methods

If a laboratory urine test confirms the presence of bacteriuria, the pregnant woman’s body is subjected to a thorough examination. She is prescribed:

• Ultrasound of the kidneys.
• Survey and excretory urography.
• Doppler measurements of the renal vessels.
• A number of screening tests.
• Laboratory blood test.

After laboratory and hardware diagnostics, the expectant mother is examined and advised by a whole group of specialists:

• urologist;
• nephrologist;
• gynecologist;
• therapist.

Having compiled a complete picture of the causes and clinical manifestations of the disease, the specialist managing the pregnancy outlines effective tactics for its treatment.

Treatment

What should an expectant mother do if bacteria are found in her urine? The answer is clear: start treatment immediately under the supervision of a qualified specialist.

• The goal of the first stage of therapy is to normalize the pH level in the urine and enhance its excretion from the body of a pregnant woman. This effect can be produced by the combined effect of diuretic herbs and natural herbal remedies (cyston is also considered the safest and most effective). Drinking cranberry juice has an excellent diuretic effect. The treating specialist will definitely prescribe a diet that does not allow the consumption of fatty, spicy, spicy and pickled foods.
• The next stage of treatment is a single attack of pathogenic microflora with antibiotics of the cephalosporin or penicillin group. The maximum duration of such a course is no more than five days. Bacteriuria of the first trimester is treated with semisynthetic drugs: ampicillin or amoxicillin. In the second trimester, new generation antibiotics are added - macrolides. Antibacterial drugs (nitrofurans) taken at night have a supporting effect. After completing treatment, its effectiveness is monitored by repeated urine culture for bacteriuria.
• To treat asymptomatic bacteriuria, more gentle methods are used: the use of herbal medicine and harmless homeopathic remedies (the same canephron and cystone). The uroantiseptic monural has a powerful effect on the body of the expectant mother. Its massive effect is allowed for only one day (three grams in the morning, afternoon and evening). If such treatment is ineffective, the expectant mother is prescribed a weekly (sometimes longer) course of cephalosporins. An integral part of treatment is strict control of the timeliness of emptying the bladder, preventing stagnation of urine. For this purpose, a pregnant woman must take diuretic infusions and fruit drinks made from rose hips and cranberries.

Basic principles of treatment
Strict medical supervision with mandatory screening tests of urine and blood.
The main criterion for choosing medications for the treatment of pregnant women is their complete safety.
When prescribing medications, it is necessary to take into account the duration of pregnancy.

The most common pathology of the urinary tract is the entry of pathogenic bacteria into the organs of the urinary system. This can happen as a result of hypothermia or an inflammatory process. In some cases, pathogenic bacteria appear in the body as a result of concomitant factors.

Thus, the spread of pathogenic bacteria in the urine - bacteriuria - can cause a decrease in the immune system or poor hygiene. Bacteriuria can occur with severe symptoms, or it can be hidden, asymptomatic, in which the tissues of the urinary organs are not affected.

What it is?

Bacteriuria is an infectious disease in which an increased presence of pathogenic microorganisms in urine is determined.

Asymptomatic (asymptomatic) bacteriuria occurs without signs of disease, symptoms of pathology. Bacteria in urine can be detected randomly when. Asymptomatic bacteriuria is diagnosed after two urine samples in the absence of clinical manifestations.

According to the table of the International Classification of Diseases (ICD-10), bacteriuria is classified as urinary tract infections without an established localization with code N39.0.

Causes of the disease

With healthy kidneys, the presence of pathogenic bacteria in them is excluded, therefore, if the kidney tissue is not damaged, then bacteria cannot penetrate into the urine through the kidneys. That's why urine infection may occur for the following reasons:

• inflammatory processes in the kidneys;
• presence of bacteria in;
• inflammation of the prostate gland.

Read our article on how to treat inflammation of the prostate gland.

Dilation of the urethra can provoke infection into the urine. Poor personal hygiene can also cause bacteria to enter the urine. In some cases, diabetes mellitus may be a concomitant factor in the development of bacteria in the urine.

Why does pathology appear in pregnant women and children?

Pathogenic microorganisms can enter the urine pregnant as a result of the following factors:

• compression of the urinary system organs by the enlarged uterus: kidneys, bladder;
• decreased immune system during pregnancy;
• the effect of progesterone on the muscle tone of the ureteric tubes;
• due to dilation of the renal pelvis;
• formation based on the physiological development of the pregnant woman;
• stagnation of urinary fluid in the bladder;
• change in the physicochemical composition of urine.

In some cases, bacterial vaginosis, undetected before pregnancy, can cause the development of asymptomatic bacteriuria during gestation. With repeated spread of pathogenic bacteria in the urine high risk of developing pyelonephritis.

Massive bacteriuria in pregnant women contributes to the asymptomatic spread of pathogenic bacteria not only in the bladder, they can spread to the tissues of neighboring organs, as well as to the uterus.

The effect of asymptomatic bacteriuria in a pregnant woman can affect the fetus. Maternal bacteriuria may contribute:

• the birth of a child before the due date;
• giving birth to an underweight child;
• infection of the fetus during intrauterine development.

If bacteria are present in the urine of a newborn, antibacterial therapy can negatively affect the baby’s health.

U children, especially in infants, asymptomatic bacteriuria can be caused by indolent kidney or urinary tract disease.

Failure to comply with hygiene standards (long stay in filled diapers), close proximity of the anus, as well as the child’s weak immunity can contribute to the development of asymptomatic bacteriuria.

Diagnostic measures

Bacteriuria, which is asymptomatic, is detected only by urine tests.

Other symptoms of urinary fluid infection may not be observed. The main microorganisms that can be found in urine are enterococcus, Klebsiella, Escherichia coli, and Lacciella.

A certain number of these microorganisms are found in any organism, however, when they get into the urine, they begin to multiply at an accelerated pace. The urine of a healthy person does not contain pathogenic bacteria: it is sterile.

The presence of bacteria can be diagnosed using a urine test.

An important condition for collecting urine for this analysis is the correctness of the collection procedure and the sterility of the container for analysis. If the collection requirements are not followed, a false test may occur, which detects bacteria that have entered the urine from hands, from an unsterile jar, or from the external genitalia.

Reanalysis A bacterial culture is taken to confirm the results after a few days. In some cases, for a correct test result, it is necessary to collect urine through a catheter. This ensures the sterility of the biomaterial for testing for bacteria.

Asymptomatic bacteriuria is defined if the number of pathogenic bacteria is 105 CFU/ml in the results of two bacterial urine cultures.

How to treat?

Effective treatment for bacteriuria is carried out using antibacterial drugs. Treatment of bacteriuria is not required for people with diabetes mellitus or patients who resort to the constant use of a urinary catheter.

In the absence of structural changes in the tissues of the urinary tract in children or adults, as well as a small amount of pathogenic microorganisms in the urine, bacteriuria is not treated, since the use of antibiotics can provoke inhibition of microflora.

Treatment of asymptomatic bacteriuria is required for newborns, school-age children, pregnant women, and men under sixty years of age.

If bacteriuria occurs as a result of catheterization, then treatment in this case consists of in a single use antibacterial drug.

In pregnant women

For pregnant women, an important condition for selecting antibacterial agents is the use of drugs that have minimal impact on the fetus.

Treatment of pregnant women boils down to taking antibacterial drugs for seven days. Taking fluorochonolones may have a negative effect on the unborn child. It is advisable to use cephalosporins, ampicillins, nitrofurans. A common drug for pregnant women is.

If bacteriuria is massive, then fosfomycin trometamol is used once. In this case, the possible risk to the fetus and the benefits of treatment for the mother are considered.

At the treatment stage, pregnant women are prescribed medications that help improve bladder emptying and accelerate the passage of urine, reducing its acidity. To improve the condition, include in the diet foods improving the composition of urinary fluid.

In children

If pathogenic bacteria are detected in the child’s urine, antibacterial therapy should be carried out, otherwise cystitis may become a side sign of the spread of bacteria in the urine.

When examining biomaterial for bacterial inoculation, it is important to identify the sensitivity of bacteria to antibiotics and prescribe an effective drug. Children who can take tablets orally use them no more than 7 days. If the child is an infant, treatment is carried out using injections.

After antibiotic therapy, all patients should undergo control test for bacterial culture to ensure the results of the treatment.

Thus, asymptomatic bacteriuria can develop against the background of decreased immunity, infection and insufficient adherence to the rules of intimate hygiene. During pregnancy, bacteriuria can be caused by structural changes in a woman’s body, especially in the organs of the urinary system.

For timely treatment of the disease, pregnant women should systematically take a urine test for bacterial culture. For prevention purposes, it is important to observe hygiene standards, as well as strengthen the immune system and monitor nutrition.

For more information about asymptomatic bacteriuria in pregnant women, watch the video: