Диагностика бессимптомной бактериурии у беременных: рациональные подходы

Asymptomatic bacteriuria (AB) during pregnancy has a negative impact on its course and also affects obstetric and perinatal outcomes.

Objective. To optimize the diagnosis of AB in pregnant women to prevent possible negative effects of asymptomatic infections on obstetric and perinatal outcomes.

Subjects and methods. A single-center prospective trial included 101 pregnant women, who in the first trimester had AB in different titers being detected by a screening bacteriological examination of their urine specimen. All the patients underwent repeated urinary bacteriological examination in compliance with all the requirements for this examination. The specific features of the course of pregnancy and perinatal outcomes were analyzed in women with bacteriuria detected in various titers. A control group consisted of 50 women without a history of urinary tract infections.

Results. The repeated examination confirmed that 9 (9.0%) patients had bacteriuria in a titer ≥10⁵ CFU/ml; 65 (70.6%) had this condition in a titer of 10²–10⁴ CFU/ml; no growth of etiologically significant microorganisms was found in 27 (29.4%) examinees. Studying the results of primary urine cultures revealed monoinfection in 72.3% of cases; a combination of two microorganisms was noted in 27.7%. The regional structure of the repeatedly isolated uropathogens is mainly represented by Enterobacteriales. The bacteriological examination of urine before antibacterial therapy repeatedly confirmed AB in a significant titer only in 9 patients (95% confidence interval, 0.042-0.162; p=0.029). Bacteriuria even through single separation of an uropathogen in a low titer during pregnancy is associated with an increased risk for mild anemia and hypertension.

Conclusion. Even the single detection of uropathogens in the urine of pregnant women, including those with a low diagnostic titer of 10²–10⁴ CFU/ml is associated with the unfavorable course of pregnancy.