Reaffirmation Recommendation Statement
July 2008
Summary of Recommendation
- The USPSTF recommends screening for asymptomatic
bacteriuria with urine culture for pregnant women at
12 to 16 weeks' gestation or at the first prenatal visit, if
later.
Grade: A recommendation.
- The USPSTF recommends against screening for
asymptomatic bacteriuria in men and nonpregnant
women.
Grade: D recommendation.
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This recommendation statement was first published in Annals of Internal Medicine. Select for copyright and source information.
Contents
Rationale
Clinical Considerations
Other Considerations
Discussion
Recommendations of Others
Members of the USPSTF
References
Rationale
Importance: In pregnant women, asymptomatic
bacteriuria has been associated with an increased incidence of pyelonephritis
and low birthweight (birthweight <2500 g).
Detection: Asymptomatic bacteriuria can be
reliably detected through urine culture. The presence of at least 105 colony-forming units per mL of urine, of a single uropathogen, and in a
midstream clean-catch specimen is considered a positive test result.
Benefits of Detection and Early Intervention: In pregnant women, convincing evidence indicates that
detection of and treatment for asymptomatic bacteriuria with antibiotics
significantly reduces the incidence of symptomatic maternal urinary tract
infections and low birthweight.
In men and nonpregnant women, adequate evidence suggests that
screening men and nonpregnant women for asymptomatic bacteriuria is ineffective
in improving clinical outcomes.
Harms of Detection and Early Treatment: Potential harms associated with treatment for asymptomatic
bacteriuria include adverse effects from antibiotics and development of
bacterial resistance. Without evidence of benefits from screening men and nonpregnant
women, the potential harms associated with overuse of antibiotics are
especially significant.
USPSTF Assessment: The USPSTF concludes that 1) in pregnant women, there is high
certainty that the net benefit of screening for asymptomatic bacteriuria is
substantial, and 2) in men and nonpregnant women, there is moderate certainty
that the harms of screening for asymptomatic bacteriuria outweigh the benefits.
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Clinical Considerations
Patient Population
This recommendation applies to the general adult
population, including adults with diabetes. The USPSTF
did not review evidence for screening certain groups at
high risk for severe urinary tract infections, such as transplant
recipients, patients with sickle cell disease, and patients
with recurrent urinary tract infections.
Screening Tests
The screening tests used commonly in the primary care setting
(dipstick analysis and direct microscopy) have poor positive and negative
predictive value for detecting bacteriuria in asymptomatic persons.1 Urine
culture is the gold standard for detecting asymptomatic bacteriuria but is
expensive for routine screening in populations with a low prevalence of the
condition. However, no currently available tests have a high enough sensitivity
and negative predictive value in pregnant women to replace the urine culture as
the preferred screening test.2
Treatment
Pregnant women with asymptomatic
bacteriuria should receive antibiotic therapy directed at the cultured organism
and follow-up monitoring.
Screening Intervals
All pregnant women should provide a clean-catch urine
specimen for a screening culture at 12 to 16 weeks' gestation or at the first
prenatal visit, if later. The optimal frequency of subsequent urine testing
during pregnancy is uncertain.
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Other Considerations
Research Needs/Gaps
Further research is needed to clarify the optimal timing and
periodicity of screening for asymptomatic bacteriuria in pregnant women.
Research is also needed to develop a screening test that could reduce the use
of urine culture, which is labor-intensive and more costly than other urine
tests.
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Discussion
In 2004, the USPSTF reviewed the evidence on screening for
asymptomatic bacteriuria in adults and recommended screening pregnant women.3
In 2008, the USPSTF performed a brief literature review2 and determined that
the net benefit of screening pregnant women and the net harm of screening men
and nonpregnant women continue to be well established. The update included a
search for new and substantial evidence on the benefits and harms of screening.
The USPSTF found no new substantial evidence that could change its
recommendation and, therefore, reaffirms its recommendation to screen pregnant
women, but not men or nonpregnant women, for asymptomatic bacteriuria. The
previous recommendation statement and evidence report,4 as well as the 2008
summary of the updated literature search can be found at www.preventiveservices.ahrq.gov.
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Recommendations of Others
The American Academy of Family Physicians strongly recommends
that all pregnant women be screened for asymptomatic bacteriuria using urine
culture at 12 to 16 weeks' gestation or at the first prenatal visit if after
that time.5
The Infectious Diseases Society of America recommends
screening pregnant women for asymptomatic bacteriuria with a urine culture "at
least once" in early pregnancy. It also states that screening for asymptomatic
bacteriuria in nonpregnant women, diabetic women, or community-dwelling or institutionalized
older persons is not indicated.6
The American Academy of Pediatrics and the American College
of Obstetricians and Gynecologists recommend screening for asymptomatic
bacteriuria "early in pregnancy, as appropriate".7
The American College of Obstetricians and Gynecologists
recommends screening for asymptomatic bacteriuria in nonpregnant women with
diabetes mellitus.8
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Members of the U.S. Preventive Services Task Force*
Ned Calonge, MD, MPH, Chair (Colorado Department of Public Health and Environment,
Denver, Colorado); Diana B. Petitti, MD, MPH , Vice Chair (Keck School
of Medicine, University of Southern California, Sierra Madre, California);Thomas
G. DeWitt, MD (Children's
Hospital Medical Center, Cincinnati, Ohio); Allen Dietrich, MD (Dartmouth Medical School, Lebanon, New
Hampshire); Kimberly D.
Gregory, MD, MPH (Cedars-Sinai Medical Center, Los Angeles, California);
Russell Harris, MD, MPH (University of North Carolina School of Medicine,
Chapel Hill, North Carolina); George Isham, MD, MS (HealthPartners, Minneapolis, Minnesota);
Michael L. LeFevre, MD, MSPH (University of Missouri School of Medicine, Columbia, Missouri); Rosanne Leipzig, MD,
PhD (Mount Sinai School of Medicine, New York, New York); Carol Loveland-Cherry, PhD, RN
(University of Michigan School of Nursing, Ann Arbor, Michigan); Lucy N. Marion, PhD, RN (School of Nursing, Medical
College of Georgia, Augusta, Georgia); Bernadette Melnyk, PhD, RN, CPNP/NPP
(Arizona State College of Nursing and Healthcare Innovation, Phoenix, Arizona); Virginia A. Moyer, MD,
MPH (University of Texas Health Science Center, Houston, Texas); Judith K.
Ockene, PhD (University of Massachusetts Medical School, Worcester, Massachusetts); George F.
Sawaya, MD (University
of California, San Francisco, San Francisco, California); and Barbara P. Yawn, MD, MSPH, MSc
(Olmsted Medical Center, Rochester, Minnesota).
*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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References
1. Screening for asymptomatic bacteriuria. In: U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; 1996:347-59.
2. Lin K, Fajardo K. Screening for asymptomatic bacteriuria
in adults: evidence for the U.S. Preventive Services Task Force reaffirmation
recommendation statement. Ann Intern Med. 2008;149:W-20-4.
3. U.S. Preventive Services Task Force. Screening for
Asymptomatic Bacteriuria: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality; 2004. Accessed at
www.ahrq.gov/clinic/uspstf/uspsbact.htm on 8 January 2008.
4. Gartlehner G, Kahwati L, Lux L, West S. Screening for
Asymptomatic Bacteriuria: A Brief Evidence Update for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality;
February 2004. AHRQ Publication No. 05-0551-B. Accessed at
www.ahrq.gov/clinic/3rduspstf/asymbac/asymbacup.pdf on 8 January 2008.
5. American Academy of Family Physicians. Summary of
recommendations for clinical preventive services. Revision 6.4. August 2007. Accessed
at www.aafp.org/online/en/home/clinical/exam.html on 8 January 2008.
6. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A,
Hooton TM, et al. Infectious Diseases Society of America guidelines for the
diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis
2005;40:643-54. [PMID: 15714408]
7. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 6th ed. Elk Grove Village, IL, and Washington, DC: American Academy of Pediatrics and American College of Obstetricians and Gynecologists; 2007:100-1.
8. ACOG Committee Opinion No. 357: Primary and preventive
care: periodic assessments. Obstet Gynecol 2006;108:1615-22. [PMID: 17138804]
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Copyright and Source Information
Source: U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: U.S. Preventive
Services Task Force Reaffirmation Recommendation Statement. Ann Intern Med 2008;149:43-47.
This document is in the public domain within the United States. For
information on reprinting, contact Randie Siegel, Associate Director, Office of Communications and Knowledge Transfer, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850.
Requests for linking or to incorporate content in electronic resources
should be sent to: info@ahrq.gov.
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AHRQ Publication No. 08-05120-EF-1
Current as of July 2008
Internet Citation:
U.S. Preventive Services Task Force. Screening for Asymptomatic Bacteriuria in Adults: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. AHRQ Publication No. 08-05120-EF-1, July 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf08/asymptbact/asbactrs.htm