NM 706 Exam 2
What is asymptomatic bacteriuria (ASB)? How is it diagnosed (lab testing used and
values that indicate asymptomatic bacteriuria)?What is the recommended management
for asymptomatic bacteriuria? What antibiotics can be used to treat asymptomatic
bacteriuria? - answerDefinition
- persistent, actively multiplying bacteria within the urinary tract of asymptomatic women
- highest incidence is in AA women with SS trait and more common in women with
diabetes
- lowest incidence is in affluent, low parity, white
- if left untreated 25-35% can lead to pyelonephritis
Diagnosis
- no s/s, asymptomatic
- Urine dipstick, UA (+nitrates, leuks)
- Urine culture (GOLD STANDARD)
- positive result if >100,000cfu/mL single organism, may consider lower colony counts of
20,000-50,000 cfu/mL
**if ANY GBS is found in the urine at any time, IP treatment during labor is
recommended*
Management
- recommend screening at first prenatal visit
- E.coli is the most common organism
- USPSTF recommends screening with urine culture at 12-16 weeks gestation or upon
PNC entry
- Up to 40% false-positive, consider confirming with 2nd culture
- Positive urine dipstick or UA order urine culture
- Educate
- S & S of UTI
- 25 - 40% develop symptoms
- PTL signs & symptoms
- Antimicrobial treatment with positive urine culture results
> 100,000 cfu/mL of a single organism
- May consider lower colony counts of 20,000 - 50,000 cfu/mL
- TOC ≈ 10 days following treatment
- Urine cultures q trimester following ASB or if sickle cell trait or DM
Antibiotics
- Amoxicillin (Amoxil) 250 mg po tid x 3-7 days
- Amoxicillin-clavulanic acid (Augmentin) 250/125 mg po qid x 3-7 days
- Cephalexin (Keflex) 500 mg qid x 3-7 days
- Ciprofloxin (Cipro) 250 mg bid x 3 days
,- Nitrofurantoin (Macrobid) 100 mg bid x 3-7 days
- Trimethoprim- sulfamethoxazole (Bactrim DS) 160/800 mg bid x 3-7days (contra in
1st/3rd tri)
Suppression Therapy
- Cephalexin (Keflex) 125-250 mg QD
- Nitrofurantoin (Macrodantin) 100 mg Q hs
Urinary Pain Relief
- Phenazopyridine (Pyridium, Uristat, Azo-Stat) 200 mg tid prn - Contraindicated with
What is acute cystitis? What is the clinical presentation of cystitis? What diagnostic tests
are used diagnose cystitis? What lab values indicate an acute cystitis infection? What is
the recommended management for cystitis? What antibiotics can be used to treat
cystitis? - answerDefinition (LOWER UTI)
- infection of the bladder and/or urethra
- 15-20% of all pregnancies-most common (TIP: pts with 2/+ s/s of UTI and no vaginal
discharge have a 90% probability of having acute cystitis)
Signs and symptoms
- dysuria
- urgency
- frequency
- bacteriuria
- possible: pyuria, hematuria
Diagnostic tests and lab values
- Urine culture (GOLD standard 24-48 hours for results)
- collected via MSCC, refrigerate if unable to examine within 2 hours of collection
- Cystitis: positive result if >1,000 cfu/mL single organism and symptomatic
Management
- Order Urine culture
- Treat empirically
- Educate: Call back if no improvement in48 hours or worsening symptoms; S & S PTL
- TOC ≈ 10 days following treatment
Antibiotics
- Amoxicillin (Amoxil) 250 mg po tid x 3-7 days
- Amoxicillin-clavulanic acid (Augmentin) 250/125 mg po qid x 3-7 days
- Cephalexin (Keflex) 500 mg qid x 3-7 days
- Ciprofloxin (Cipro) 250 mg bid x 3 days
- Nitrofurantoin (Macrobid) 100 mg bid x 3-7 days
- Trimethoprim- sulfamethoxazole (Bactrim DS) 160/800 mg bid x 3-7days (contra in
1st/3rd tri)
, Suppression Therapy
- Cephalexin (Keflex) 125-250 mg QD
- Nitrofurantoin (Macrodantin) 100 mg Q hs
Urinary Pain Relief
- Phenazopyridine (Pyridium, Uristat, Azo-Stat) 200 mg tid prn - Contraindicated with
G6PD
What is pyelonephritis? What is the relationship between ASB or cystitis and
pyelonephritis? What are the presenting symptoms for pyelonephritis? What are the
differential diagnoses for pyelonephritis? What diagnostic tests are used to differentiate
pyelonephritis? What lab values indicate acute pyelonephritis? How can the nurse-
midwife manage pyelonephritis? - answerDefinition (UPPER UTI)
- infection of the renal parenchyma
- leading cause of septic shock in pregnancy
Maternal implications
- HTN/preeclampsia, Anemia, PTL/PTB, Acute renal failure, Sepsis, PE, ARDS
Fetal implications
- LBW, PTB, FGR, Stillbirth
- Early pg: teratogenic effects from high fever; urosepsis may be related to cerebral
palsy in the preterm infant
Signs and symptoms
Symptoms of cystitis plus
- Fever, shaking/chills, anorexia, N/V, myalgia
- Flank pain, CVA tenderness
- ½ of cases are unilateral and R-sided, ¼ of cases are bilateral
Diagnostic tests and lab values
- Urine dipstick, U/A, or urine culture (GOLD standard)
- Pyelonephritis- >10,000 cfu/mL single organism and symptomatic
Management
- Physician referral, Inpatient
- At risk for: ARDS, Acute kidney injury, Endotoxin-induced hemolysis, Maternal sepsis
- Obtain urine and possible blood cultures
- Evaluate hemogram, serum creatinine, & electrolytes
- Chest x-ray if dyspnea or tachypnea
- Frequent monitoring of VS & urine output
- IV fluids and antimicrobials
- Change to oral antimicrobials when afebrile x 48 hours
- Discharge when afebrile home on antimicrobial therapy x 7-14 days
- Repeat urine culture 1-2 weeks after antimicrobial therapy completed
Antibiotics
First line
- Cefazolin (Ancef) 102g IV q6-8 hours w or w/out gentamicin
What is asymptomatic bacteriuria (ASB)? How is it diagnosed (lab testing used and
values that indicate asymptomatic bacteriuria)?What is the recommended management
for asymptomatic bacteriuria? What antibiotics can be used to treat asymptomatic
bacteriuria? - answerDefinition
- persistent, actively multiplying bacteria within the urinary tract of asymptomatic women
- highest incidence is in AA women with SS trait and more common in women with
diabetes
- lowest incidence is in affluent, low parity, white
- if left untreated 25-35% can lead to pyelonephritis
Diagnosis
- no s/s, asymptomatic
- Urine dipstick, UA (+nitrates, leuks)
- Urine culture (GOLD STANDARD)
- positive result if >100,000cfu/mL single organism, may consider lower colony counts of
20,000-50,000 cfu/mL
**if ANY GBS is found in the urine at any time, IP treatment during labor is
recommended*
Management
- recommend screening at first prenatal visit
- E.coli is the most common organism
- USPSTF recommends screening with urine culture at 12-16 weeks gestation or upon
PNC entry
- Up to 40% false-positive, consider confirming with 2nd culture
- Positive urine dipstick or UA order urine culture
- Educate
- S & S of UTI
- 25 - 40% develop symptoms
- PTL signs & symptoms
- Antimicrobial treatment with positive urine culture results
> 100,000 cfu/mL of a single organism
- May consider lower colony counts of 20,000 - 50,000 cfu/mL
- TOC ≈ 10 days following treatment
- Urine cultures q trimester following ASB or if sickle cell trait or DM
Antibiotics
- Amoxicillin (Amoxil) 250 mg po tid x 3-7 days
- Amoxicillin-clavulanic acid (Augmentin) 250/125 mg po qid x 3-7 days
- Cephalexin (Keflex) 500 mg qid x 3-7 days
- Ciprofloxin (Cipro) 250 mg bid x 3 days
,- Nitrofurantoin (Macrobid) 100 mg bid x 3-7 days
- Trimethoprim- sulfamethoxazole (Bactrim DS) 160/800 mg bid x 3-7days (contra in
1st/3rd tri)
Suppression Therapy
- Cephalexin (Keflex) 125-250 mg QD
- Nitrofurantoin (Macrodantin) 100 mg Q hs
Urinary Pain Relief
- Phenazopyridine (Pyridium, Uristat, Azo-Stat) 200 mg tid prn - Contraindicated with
What is acute cystitis? What is the clinical presentation of cystitis? What diagnostic tests
are used diagnose cystitis? What lab values indicate an acute cystitis infection? What is
the recommended management for cystitis? What antibiotics can be used to treat
cystitis? - answerDefinition (LOWER UTI)
- infection of the bladder and/or urethra
- 15-20% of all pregnancies-most common (TIP: pts with 2/+ s/s of UTI and no vaginal
discharge have a 90% probability of having acute cystitis)
Signs and symptoms
- dysuria
- urgency
- frequency
- bacteriuria
- possible: pyuria, hematuria
Diagnostic tests and lab values
- Urine culture (GOLD standard 24-48 hours for results)
- collected via MSCC, refrigerate if unable to examine within 2 hours of collection
- Cystitis: positive result if >1,000 cfu/mL single organism and symptomatic
Management
- Order Urine culture
- Treat empirically
- Educate: Call back if no improvement in48 hours or worsening symptoms; S & S PTL
- TOC ≈ 10 days following treatment
Antibiotics
- Amoxicillin (Amoxil) 250 mg po tid x 3-7 days
- Amoxicillin-clavulanic acid (Augmentin) 250/125 mg po qid x 3-7 days
- Cephalexin (Keflex) 500 mg qid x 3-7 days
- Ciprofloxin (Cipro) 250 mg bid x 3 days
- Nitrofurantoin (Macrobid) 100 mg bid x 3-7 days
- Trimethoprim- sulfamethoxazole (Bactrim DS) 160/800 mg bid x 3-7days (contra in
1st/3rd tri)
, Suppression Therapy
- Cephalexin (Keflex) 125-250 mg QD
- Nitrofurantoin (Macrodantin) 100 mg Q hs
Urinary Pain Relief
- Phenazopyridine (Pyridium, Uristat, Azo-Stat) 200 mg tid prn - Contraindicated with
G6PD
What is pyelonephritis? What is the relationship between ASB or cystitis and
pyelonephritis? What are the presenting symptoms for pyelonephritis? What are the
differential diagnoses for pyelonephritis? What diagnostic tests are used to differentiate
pyelonephritis? What lab values indicate acute pyelonephritis? How can the nurse-
midwife manage pyelonephritis? - answerDefinition (UPPER UTI)
- infection of the renal parenchyma
- leading cause of septic shock in pregnancy
Maternal implications
- HTN/preeclampsia, Anemia, PTL/PTB, Acute renal failure, Sepsis, PE, ARDS
Fetal implications
- LBW, PTB, FGR, Stillbirth
- Early pg: teratogenic effects from high fever; urosepsis may be related to cerebral
palsy in the preterm infant
Signs and symptoms
Symptoms of cystitis plus
- Fever, shaking/chills, anorexia, N/V, myalgia
- Flank pain, CVA tenderness
- ½ of cases are unilateral and R-sided, ¼ of cases are bilateral
Diagnostic tests and lab values
- Urine dipstick, U/A, or urine culture (GOLD standard)
- Pyelonephritis- >10,000 cfu/mL single organism and symptomatic
Management
- Physician referral, Inpatient
- At risk for: ARDS, Acute kidney injury, Endotoxin-induced hemolysis, Maternal sepsis
- Obtain urine and possible blood cultures
- Evaluate hemogram, serum creatinine, & electrolytes
- Chest x-ray if dyspnea or tachypnea
- Frequent monitoring of VS & urine output
- IV fluids and antimicrobials
- Change to oral antimicrobials when afebrile x 48 hours
- Discharge when afebrile home on antimicrobial therapy x 7-14 days
- Repeat urine culture 1-2 weeks after antimicrobial therapy completed
Antibiotics
First line
- Cefazolin (Ancef) 102g IV q6-8 hours w or w/out gentamicin
