Primary Care Management of Urinary Tract Infection in Pregnant Women Dr. Charlotte Cooke 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. 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 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. 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. 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. 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. References 1)Vazquez JC, Villar J. Treatments for symptomatic urinary tract infections during pregnancy (Cochrane Review). In: The Cochrane Library, Issue Chichester, UK: John Wiley and Sons Ltd. 2)National Institute for Health and Clinical Excellence. Antenatal Care: routine care for the healthy pregnant women. London: NICE; (Clinical Guideline 6) 3)Smaill F. Antibiotics for asymptomatic bacteriuria in pregnancy (Cochrane Review). In: The Cochrane Library, Issue Chichester, UK: John Wiley and Sons Ltd. 4)SCOTTISH INTERCOLLEGIATE GUIDELINES NETWORK (2006). Management of Suspected Bacterial Urinary Tract Infection in Adults. Edinburgh: SIGN. Conclusion Guidelines were met on investigation, with 100% of cultures sent for ante- natal screening and symptomatic women. Areas identified for improvement included: the prescription of antibiotics and follow up management. Conclusion Guidelines were met on investigation, with 100% of cultures sent for ante- natal screening and symptomatic women. Areas identified for improvement included: the prescription of antibiotics and follow up management. Results 4 UTI’s were discovered upon screening and 43 were clinically suspected. 100% of women were screened with a urine culture at their 1 st antenatal appointment. 100% of women with a suspected UTI had a urine culture sent. 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. Results 4 UTI’s were discovered upon screening and 43 were clinically suspected. 100% of women were screened with a urine culture at their 1 st antenatal appointment. 100% of women with a suspected UTI had a urine culture sent. 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. Standards/ Guidance SIGN advised the following management. 4 Appropriate investigations should be carried out: A urine culture should be performed routinely at first antenatal visit. For pregnant women with a suspected UTI a single urine culture should be taken. Appropriate treatment should be prescribed: A seven day course of antibiotics should be given empirically in suspected UTI or therapeutically in proven UTI. First line antibiotics include; amoxicillin, cefalexin and nitrofurantoin. Trimethoprim should be avoided, particularly in folate deficient women. For women with a proven UTI, routine follow up should include: A urine culture 7 days post antibiotic treatment. Monthly urine cultures throughout pregnancy. Standards/ Guidance SIGN advised the following management. 4 Appropriate investigations should be carried out: A urine culture should be performed routinely at first antenatal visit. For pregnant women with a suspected UTI a single urine culture should be taken. Appropriate treatment should be prescribed: A seven day course of antibiotics should be given empirically in suspected UTI or therapeutically in proven UTI. First line antibiotics include; amoxicillin, cefalexin and nitrofurantoin. Trimethoprim should be avoided, particularly in folate deficient women. For women with a proven UTI, routine follow up should include: A urine culture 7 days post antibiotic treatment. Monthly urine cultures throughout pregnancy. Recommendations A new service should be implemented to ensure follow up of pregnant women with a proven UTI. 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. Doctors should chase results and midwives track progress at each antenatal appointment. Once firmly established a re-audit should be performed in 6-12 months time. Recommendations A new service should be implemented to ensure follow up of pregnant women with a proven UTI. 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. Doctors should chase results and midwives track progress at each antenatal appointment. Once firmly established a re-audit should be performed in 6-12 months time.