UTI During Pregnancy: Risks, Concerns & What to Do

Question
Dr. Rappaport,

I am 15 weeks pregnant with my second child.  At my first OB visit at 8 weeks my doctor took a urine sample among other tests.  I heard nothing from her office but then at my next visit (12 weeks), this time with her midwife, I was informed that the first urine test indicated a signifiant UTI.  The midwife was quite alarmed that no one had contacted me and said the infection was "a bad one."  I had mistaken the symptoms for normal pregnancy signs.  I have now been on two different courses of antibiotics and still have the infection which means that I have been sick for atleast 8 weeks!  
I am extremely concerned about the risk this prolonged infection poses to my baby.  My doctor  has mentioned low birth weight and growth retardation, as well as my risk for a kidney infection.  However, I feel somewhat sure that she and her staff are trying to cover for the fact that they dropped the ball in the first place, which has prompted me to look for advice elsewhere.  
Can you tell me about the risks of prolonged, initially untreated, UTIs and antibiotic use (Macrobid and Cephalexin- I am allergic to sulfas and cillins)?
Furthermore are there questions that I should be asking my doctor at this point?  I have considered switching OBs but no one I know has really recommended anyone and I fear that if I switch by picking someone from my insurance directory I may end up in a worse situation.  My first delivery was difficult and ended in a C-section.  My OB at that time proved to by farely neglegent and unreliable so I am a little tender this time around.  I really just want my doctor to be competent and consistent.  

Thank you for your help.
Jennifer Shaffer

Answer
A missed UTI will not really cause any harm to the pregnancy or to the baby. YOu are being treated now and the medications are safe for use during pregnancy. There are no risks to the fetus with the use of Macrobid and Keflex (cephalexin) so you can continue to take them. I would repeat the urine culture and see what comes up. If there are less than 100,000 colonies, you need not worry at all. If you have continued positive cultures and they do not respond to antibiotics, the infection can, indeed, ascend to the kidneys and you may need more antibiotics. However, you should have no problems with the pregnancy. Find out what the organism was. If the organism is Group B Strep, there is a slight risk of preterm labor if left untreated. From what you describe, you appear to have been treated adequately. Just make sure you follow up with another urine C&S (culture and sensitivity) to make sure that you no longer have a high colony count.