Abstract / Summary
Abstract Background Urinary tract infection (UTI) is one of the most frequent bacterial infections during pregnancy and is related with adverse maternal and newborn outcomes, including preterm labour. Although Lactobacillus species compose the typical vaginal microbiota and are widely regarded as non-pathogenic commensals, emerging data suggests that they can occasionally behave as opportunistic pathogens under specific clinical situations. We describe a rare instance of a late-pregnancy symptomatic UTI brought on by Lactobacillus species, underscoring the difficulties in diagnosing and treating this uncommon uropathogen. Case Presentation: A 29-year-old gravida 3, para 1, abortion 1 woman at 37 weeks and 6 days of gestation presented with burning micturition, increased urine frequency, and lower abdomen pain. Pyuria was detected by urine microscopy (8–10 pus cells/high-power field). Significant pure development of Lactobacillus species was seen in midstream urine culture; this was verified by repeat culture, ruling out contamination. Conventional microbiological techniques were used to identify the isolate, which showed resistance to ampicillin, cefixime, and cefotaxime but susceptibility to amoxicillin–clavulanate, erythromycin, clindamycin, and vancomycin. After receiving targeted treatment with intravenous amoxicillin–clavulanate, the patient had total clinical recovery despite failing empirical cefixime medication. The microbiological cure was confirmed by a sterile follow-up urine culture. The patient went into labour while in the hospital and gave birth to a healthy baby. Conclusion This case shows that when Lactobacillus species are regularly recovered in pure culture from symptomatic pregnant individuals with pyuria and chronic urine symptoms, they should not be routinely written off as contaminants. Accurate diagnosis and suitable treatment depend on the correlation of microbiological results with clinical characteristics, repeat urine culture, and culture-guided antibiotic medication. A greater understanding of Lactobacillus as a possible opportunistic uropathogen could enhance maternal outcomes and promote antibiotic stewardship during pregnancy.