Asymptomatic Bacteriuria in Pregnancy Complicated by Pyelonephritis Requiring Nephrectomy

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Nephrology

Background:

• Asymptomatic bacteriuria (ASB) affects 2-7% of pregnancies in the US.
• ASB screening is a routine part of prenatal care.
• Untreated ASB can progress to pyelonephritis and kidney damage.

Observation:

• A case of multidrug-resistant Klebsiella-induced ASB was identified during prenatal screening.
• The ASB was initially untreated due to mixed flora on a repeat urine culture.
• The patient later developed postpartum pyelonephritis and a perinephric abscess, necessitating a radical nephrectomy.

Findings:

• Current guidelines recommend treating ASB based on specific quantitative urine culture criteria.
• A single case highlights the potential for severe postpartum complications from inadequately treated ASB.
• Multidrug-resistant organisms pose a significant challenge in managing ASB during pregnancy.

Implications:

• Consider repeat urine culture testing every trimester for pregnant women with ASB or high-risk factors.
• Enhanced monitoring may prevent severe complications like pyelonephritis and kidney abscess.
• This case underscores the importance of vigilant management of ASB in prenatal care to safeguard maternal health.