UTI at 25th week of pregnancy


Q: Hi,

I am 25 weeks pregnant and just got a call yesterday from the Doctor's office that they found UTI in my urine sample. This was strange to me since I do not have any symptoms of UTI, but they said it was asymptomatic. They recommended I start taking Macrobid.
Since I'm somewhat worried about taking unnecessary medication during my pregnancy, I went out and bought a home test kit (AZO) for UTI. The test showed traces of leukocytes but negative on the nitrates. Also, I just remembered that the doctor's office mentioned the culture came back with 50,000 CFU but reading more on it I see that only 100,000+ is considered an asymptomatic UTI. I've also read that testing positive for UTI at this stage of pregnancy is extremely rare, only %1-2?
I went to a walk in clinic today and asked them to perform another test. Unfortunately results take several days, and I'm not sure if I should start on the antibiotics or wait a few more days.
Looking for any suggestions or advice on what to do.

Thanks in advance.


A:   Asymptomatic bacteriuria in pregnancy is defined as presence of bacteria in two consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts of ≥10 5 cfu/mL. Practically, however treatment is started after one voided sample tests positive.
Asymptomatic bacteriuria roughly affects 2 - 7 percent of all pregnant woman. Screening urine samples for bacterial infection is recommended even in the absence of symptoms because roughly 40 percent of pregnant women with bacteria in their urine will end up suffering from acute pyelonephritis (an infection of the kidneys) which can be quite serios in pregnancy. It is also known to be associated with low birth weight babies and preterm labour.
Hence antibiotics are recommended by the World Health Organisation (WHO) for the treatment of asymptomatic bacteriuria in pregnancy as they decrease the incidence of pyelonephritis in the treated women. Antibiotic therapy also appears to reduce the incidence of low-birth-weight and preterm babies.
Nitrofurantoin (Macrobid) is the first line of treatment recommended. It is a FDA approved Category B drug in pregnancy. It has been reported to cause hemolytic anemia in the mother and fetus if they are deficient in the G-6 P D enzyme. Hence it is recommended to start therapy with macrobid only after confirming that there is no G6PD deficiency in the mother.
It is thus recommended that you undergo antibiotic therapy for the asymptomatic bacteruria you are suffering from as it is in the best interest of your and your baby's health.

Comments / Follow Ups

Patient: But if the cutoff for UTI is 100,000 CFU, and I only have 50,000, doesn't that mean I don't have UTI?
Why take antibiotics for something I don't have?

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