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Инфекции мочевыводящих путей у беременных. Новые возможности противорецидивной терапии
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Аннотация
Инфекционные процессы мочевыводящих путей – группа часто встречающихся в клинической практике заболеваний, и в первую очередь это касается беременных женщин, у которых с ранних сроков беременности развиваются функциональные изменения мочевыводящих путей. Наиболее частым патологическим состоянием во время беременности является бессимптомная бактериурия. При позднем назначении антибактериальных препаратов, назначении без учета чувствительности возбудителей, недостаточных терапевтических дозах может развиться восходящая инфекция, приводящая к развитию гестационного пиелонефрита и другим осложнениям беременности. С целью лечения рекомендуется применение антибактериальной терапии, для профилактики рецидивирования целесообразно назначение экстракта клюквы, содержащего проантоцианидин А или другие доказательно эффективные фитопрепараты, обязательным является диспансерное наблюдение за этой группой пациенток.
Ключевые слова: инфекции мочевыводящих путей, беременность, бессимптомная бактериурия, гестационный пиелонефрит, экстракт клюквы, проантоцианидин.
Ключевые слова: инфекции мочевыводящих путей, беременность, бессимптомная бактериурия, гестационный пиелонефрит, экстракт клюквы, проантоцианидин.
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Infectious processes of the urinary tract are a group of diseases often encountered in clinical practice. In particular this applies to pregnant women in early pregnancy who develop functional changes in the urinary tract. The most common pathological condition during pregnancy is asymptomatic bacteriuria. For antibacterial drugs, prescribed on the late stages with no consideration of causative agents’ sensitivity, or inadequate therapeutic doses ascending infection leading to the development of gestational pyelonephritis and other complications of pregnancy may develop. For best preventive treatment the use of antibiotic therapy, prophylactics like cranberry extract containing proanthocyanidin A or other demonstrably effective herbal based drugs, is recommended. As for the medical check-up for this group of patients, it goes without saying that it is obligatory.
Key words: urinary tract infection, pregnancy, asymptomatic bacteriuria, gestational pyelonephritis, cranberry extract, proanthocyanidin.
Полный текст
Список литературы
1. Шехтман М.М. Руководство по экстрагенитальной патологии у беременных. Изд. 3-е. М.: Триада, 2005.
2. Урология. Национальное руководство. Под ред. Н.А.Лопаткина. М.: ГЭОТАР-Медиа, 2009.
3. Никонов А.П. Асцатурова О.Р., Шулутко П.А., Каптильный В.А. Инфекции мочевыводящих путей и беременность. Гинекология. 2007; 9 (1): 38–40.
4. Tseng CC, Huang JJ, Ko WC et al. Decreased predominance of pap G class II allele in Escherichia coli strains isolated from adults with acute pyelonephritis and urinary tract abnormalities. J Urol 2001; 166: 1643–6.
5. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am J Med Sci 2012; 4 (7): 316–9; doi: 10.4103/1947-2714.98591.
6. Rizvi M, Khan F, Shukla I et al. Rising prevalence of antimicrobial resistance in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011; 3 (2): 98–103; doi: 10.4103/0974-2727.86842.
7. Nicolle LE, Bradley S, Colgan R et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40: 643.
8. Ben David S, Einarson T, Ben David Y et al. The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis. Fundam Clin Pharmacol 1995; 9: 503.
9. Stein GE. Single-dose treatment of acute cystitis with fosfomycin tromethamine. Ann Pharmacother 1998; 32: 215.
10. Estebanez A et al. Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Eur J Clin Microbiol Infect Dis 2009; 28 (12): 1457–64; doi: 10.1007/s10096-009-0805-6. Epub 2009.
11. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev 2007; CD000490.
12. Archabald KL, Friedman A, Raker CA, Anderson BL. Impact of trimester on morbidity of acute pyelonephritis in pregnancy. Am J Obstet Gynecol 2009; 201: 406.e1.
13. Wing DA, Hendershott CM, Debuque L, Millar LK. A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy. Obstet Gynecol 1998; 92: 249.
14. Artero A, Alberola J, Eiros JM et al. Pyelonephritis in pregnancy. How adequate is empirical treatment? Rev Esp Quimioter 2013; 26 (1): 30–3.
15. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am Med Sci 2012; 4 (7): 316–9.
16. Пушкарь Д.Ю., Зайцев А.В. Современный взгляд на применение цефиксима в лечении инфекции мочевыводящих путей. РМЖ. Хирургия. Урология. 2010; 18 (29): 1809–12.
17. Айламазян Э.К. Применение цефиксима при неосложненном пиелонефрите беременных (методические рекомендации для акушеров-гинекологов). Гинекология. 2006; 3: 28–31.
18. Пушкарь Д.Ю., Зайцев А.В. Современный взгляд на применение цефиксима в лечении инфекции мочевыводящих путей. РМЖ. Хирургия. Урология. 2010; 29.
19. Alemu A, Moges F, Shiferaw Y et al. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at University of Gondar Teaching Hospital, Northwest Ethiopia. BMC Res Notes 2012; 5: 197; doi: 10.1186/1756-0500-5-197.
20. Rizvi M et al Rising prevalence of antimicrobal resistence in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011; 3 (2): 98–103.
21. Guay DR. Cranberry and urinary tract infections. Drugs 2009; 69 (7): 775–807.
22. Cimolai N, Cimolai T. The cranberry and the urinary tract. Eur J Clin Microbiol Infect Dis 2007; 26 (11): 767–76.
23. Gupta K, Chou MY, Howell A et al. Cranberry products inhibit adherence of p-fimbriated Escherichia coli to primary cultured bladder and vaginal epithelial cells. J Urol 2007; 177 (6): 2357–60.
24. Afshar K, Stothers L, Scott H, MacNeily AE. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol 2012; 188 (4 Suppl.): 1584–7; doi: 10.1016/j.juro.2012.02.031. Epub 2012.
25. Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008; 180 (4): 1367–72; doi: 10.1016/j.juro.2008.06.016. Epub 2008.
26. Dugoua JJ, Seely D, Perri D et al. Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol 2008; 15 (1): e80–6.
27. Hisano M, Bruschini H, Nicodemo AC, Srougi M. Cranberries and lower urinary tract infection prevention. Clinics (Sao Paulo) 2012; 67 (6): 661–8.
28. Wojnicz D, Sycz Z, Walkowski S et al. Study on the influence of cranberry extract Żuravit S•O•S(R) on the properties of uropathogenic Escherichia coli strains, their ability to form biofilm and its antioxidant properties. Phytomedicine 2012; 19 (6): 506–14; doi: 10.1016/j.phymed.2011.12.013. Epub 2012.
29. McMurdo ME, Argo I, Phillips G et al. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trialinolder women. J Antimicrob Chemother 2009; 63: 389–95.
2. Урология. Национальное руководство. Под ред. Н.А.Лопаткина. М.: ГЭОТАР-Медиа, 2009.
3. Никонов А.П. Асцатурова О.Р., Шулутко П.А., Каптильный В.А. Инфекции мочевыводящих путей и беременность. Гинекология. 2007; 9 (1): 38–40.
4. Tseng CC, Huang JJ, Ko WC et al. Decreased predominance of pap G class II allele in Escherichia coli strains isolated from adults with acute pyelonephritis and urinary tract abnormalities. J Urol 2001; 166: 1643–6.
5. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am J Med Sci 2012; 4 (7): 316–9; doi: 10.4103/1947-2714.98591.
6. Rizvi M, Khan F, Shukla I et al. Rising prevalence of antimicrobial resistance in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011; 3 (2): 98–103; doi: 10.4103/0974-2727.86842.
7. Nicolle LE, Bradley S, Colgan R et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40: 643.
8. Ben David S, Einarson T, Ben David Y et al. The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis. Fundam Clin Pharmacol 1995; 9: 503.
9. Stein GE. Single-dose treatment of acute cystitis with fosfomycin tromethamine. Ann Pharmacother 1998; 32: 215.
10. Estebanez A et al. Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Eur J Clin Microbiol Infect Dis 2009; 28 (12): 1457–64; doi: 10.1007/s10096-009-0805-6. Epub 2009.
11. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev 2007; CD000490.
12. Archabald KL, Friedman A, Raker CA, Anderson BL. Impact of trimester on morbidity of acute pyelonephritis in pregnancy. Am J Obstet Gynecol 2009; 201: 406.e1.
13. Wing DA, Hendershott CM, Debuque L, Millar LK. A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy. Obstet Gynecol 1998; 92: 249.
14. Artero A, Alberola J, Eiros JM et al. Pyelonephritis in pregnancy. How adequate is empirical treatment? Rev Esp Quimioter 2013; 26 (1): 30–3.
15. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am Med Sci 2012; 4 (7): 316–9.
16. Пушкарь Д.Ю., Зайцев А.В. Современный взгляд на применение цефиксима в лечении инфекции мочевыводящих путей. РМЖ. Хирургия. Урология. 2010; 18 (29): 1809–12.
17. Айламазян Э.К. Применение цефиксима при неосложненном пиелонефрите беременных (методические рекомендации для акушеров-гинекологов). Гинекология. 2006; 3: 28–31.
18. Пушкарь Д.Ю., Зайцев А.В. Современный взгляд на применение цефиксима в лечении инфекции мочевыводящих путей. РМЖ. Хирургия. Урология. 2010; 29.
19. Alemu A, Moges F, Shiferaw Y et al. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at University of Gondar Teaching Hospital, Northwest Ethiopia. BMC Res Notes 2012; 5: 197; doi: 10.1186/1756-0500-5-197.
20. Rizvi M et al Rising prevalence of antimicrobal resistence in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011; 3 (2): 98–103.
21. Guay DR. Cranberry and urinary tract infections. Drugs 2009; 69 (7): 775–807.
22. Cimolai N, Cimolai T. The cranberry and the urinary tract. Eur J Clin Microbiol Infect Dis 2007; 26 (11): 767–76.
23. Gupta K, Chou MY, Howell A et al. Cranberry products inhibit adherence of p-fimbriated Escherichia coli to primary cultured bladder and vaginal epithelial cells. J Urol 2007; 177 (6): 2357–60.
24. Afshar K, Stothers L, Scott H, MacNeily AE. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol 2012; 188 (4 Suppl.): 1584–7; doi: 10.1016/j.juro.2012.02.031. Epub 2012.
25. Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008; 180 (4): 1367–72; doi: 10.1016/j.juro.2008.06.016. Epub 2008.
26. Dugoua JJ, Seely D, Perri D et al. Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol 2008; 15 (1): e80–6.
27. Hisano M, Bruschini H, Nicodemo AC, Srougi M. Cranberries and lower urinary tract infection prevention. Clinics (Sao Paulo) 2012; 67 (6): 661–8.
28. Wojnicz D, Sycz Z, Walkowski S et al. Study on the influence of cranberry extract Żuravit S•O•S(R) on the properties of uropathogenic Escherichia coli strains, their ability to form biofilm and its antioxidant properties. Phytomedicine 2012; 19 (6): 506–14; doi: 10.1016/j.phymed.2011.12.013. Epub 2012.
29. McMurdo ME, Argo I, Phillips G et al. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trialinolder women. J Antimicrob Chemother 2009; 63: 389–95.
________________________________________________
1. Шехтман М.М. Руководство по экстрагенитальной патологии у беременных. Изд. 3-е. М.: Триада, 2005.
2. Урология. Национальное руководство. Под ред. Н.А.Лопаткина. М.: ГЭОТАР-Медиа, 2009.
3. Никонов А.П. Асцатурова О.Р., Шулутко П.А., Каптильный В.А. Инфекции мочевыводящих путей и беременность. Гинекология. 2007; 9 (1): 38–40.
4. Tseng CC, Huang JJ, Ko WC et al. Decreased predominance of pap G class II allele in Escherichia coli strains isolated from adults with acute pyelonephritis and urinary tract abnormalities. J Urol 2001; 166: 1643–6.
5. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am J Med Sci 2012; 4 (7): 316–9; doi: 10.4103/1947-2714.98591.
6. Rizvi M, Khan F, Shukla I et al. Rising prevalence of antimicrobial resistance in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011; 3 (2): 98–103; doi: 10.4103/0974-2727.86842.
7. Nicolle LE, Bradley S, Colgan R et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40: 643.
8. Ben David S, Einarson T, Ben David Y et al. The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis. Fundam Clin Pharmacol 1995; 9: 503.
9. Stein GE. Single-dose treatment of acute cystitis with fosfomycin tromethamine. Ann Pharmacother 1998; 32: 215.
10. Estebanez A et al. Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Eur J Clin Microbiol Infect Dis 2009; 28 (12): 1457–64; doi: 10.1007/s10096-009-0805-6. Epub 2009.
11. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev 2007; CD000490.
12. Archabald KL, Friedman A, Raker CA, Anderson BL. Impact of trimester on morbidity of acute pyelonephritis in pregnancy. Am J Obstet Gynecol 2009; 201: 406.e1.
13. Wing DA, Hendershott CM, Debuque L, Millar LK. A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy. Obstet Gynecol 1998; 92: 249.
14. Artero A, Alberola J, Eiros JM et al. Pyelonephritis in pregnancy. How adequate is empirical treatment? Rev Esp Quimioter 2013; 26 (1): 30–3.
15. Sabharwal ER. Antibiotic susceptibility patterns of uropathogens in obstetric patients. N Am Med Sci 2012; 4 (7): 316–9.
16. Пушкарь Д.Ю., Зайцев А.В. Современный взгляд на применение цефиксима в лечении инфекции мочевыводящих путей. РМЖ. Хирургия. Урология. 2010; 18 (29): 1809–12.
17. Айламазян Э.К. Применение цефиксима при неосложненном пиелонефрите беременных (методические рекомендации для акушеров-гинекологов). Гинекология. 2006; 3: 28–31.
18. Пушкарь Д.Ю., Зайцев А.В. Современный взгляд на применение цефиксима в лечении инфекции мочевыводящих путей. РМЖ. Хирургия. Урология. 2010; 29.
19. Alemu A, Moges F, Shiferaw Y et al. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at University of Gondar Teaching Hospital, Northwest Ethiopia. BMC Res Notes 2012; 5: 197; doi: 10.1186/1756-0500-5-197.
20. Rizvi M et al Rising prevalence of antimicrobal resistence in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011; 3 (2): 98–103.
21. Guay DR. Cranberry and urinary tract infections. Drugs 2009; 69 (7): 775–807.
22. Cimolai N, Cimolai T. The cranberry and the urinary tract. Eur J Clin Microbiol Infect Dis 2007; 26 (11): 767–76.
23. Gupta K, Chou MY, Howell A et al. Cranberry products inhibit adherence of p-fimbriated Escherichia coli to primary cultured bladder and vaginal epithelial cells. J Urol 2007; 177 (6): 2357–60.
24. Afshar K, Stothers L, Scott H, MacNeily AE. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol 2012; 188 (4 Suppl.): 1584–7; doi: 10.1016/j.juro.2012.02.031. Epub 2012.
25. Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008; 180 (4): 1367–72; doi: 10.1016/j.juro.2008.06.016. Epub 2008.
26. Dugoua JJ, Seely D, Perri D et al. Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol 2008; 15 (1): e80–6.
27. Hisano M, Bruschini H, Nicodemo AC, Srougi M. Cranberries and lower urinary tract infection prevention. Clinics (Sao Paulo) 2012; 67 (6): 661–8.
28. Wojnicz D, Sycz Z, Walkowski S et al. Study on the influence of cranberry extract Żuravit S•O•S(R) on the properties of uropathogenic Escherichia coli strains, their ability to form biofilm and its antioxidant properties. Phytomedicine 2012; 19 (6): 506–14; doi: 10.1016/j.phymed.2011.12.013. Epub 2012.
29. McMurdo ME, Argo I, Phillips G et al. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trialinolder women. J Antimicrob Chemother 2009; 63: 389–95.
Авторы
А.В.Ледина, В.Н.Прилепская
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва
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A.V.Ledina, V.N.Prilepskaya
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