Recommendations on screening for asymptomatic bacteriuria in pregnancy

Moore, Ainsley; Doull, Marion; Grad, Roland; Groulx, Stéphane; Pottie, Kevin; Courage, Susan; Garcia, Alejandra Jaramillo; Thombs, Brett D.

doi:10.1503/cmaj.171325

Cited by 48 publications

(61 citation statements)

References 20 publications

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“…9,10 Treatment of asymptomatic bacteriuria is recommended based on the assumption that it can lead to better birth outcomes. 5,6 However, similar to ours, several studies have suggested that the risk of early delivery among women with a UTI persists despite treatment. 11,25,26 We showed that women were at elevated risk of PTB regardless of treatment when the UTI was diagnosed at an inpatient or outpatient visit within 6 months of delivery.…”

Section: Discussionsupporting

confidence: 84%

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

Baer

Nidey

Bandoli

et al. 2021

AJP Rep

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Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy. Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa. Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1–1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated). Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.

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Section: Discussionsupporting

confidence: 84%

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

Baer

Nidey

Bandoli

et al. 2021

AJP Rep

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“…The Canadian Task Force on Preventive Health Care recommends screening pregnant women once for ASB during the first trimester with urine culture 21 . The United States Preventive Services Task Force recommends screening with urine culture for pregnant women at 12–16 weeks of gestation or at their first prenatal visit, if later 22 . The National Institute for Health and Care Excellence, UK, recommends routine screening early in pregnancy 23 .…”

Section: Discussionmentioning

confidence: 99%

Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35–37 weeks of pregnancy

Khalil

Uldbjerg

Thorsen

et al. 2020

Intl J Gynecology & Obste

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Objective To evaluate whether systematic antepartum screening for Group B Streptococci (GBS) by urine culture improves the risk factor‐based selection of pregnant women for intrapartum GBS screening with a rapid polymerase chain reaction (PCR) assay. Methods A prospective observational study was conducted between April 2013 and June 2014. GBS colonization judged by urine culture at 35–37 weeks of gestation was compared with the result of a vaginal GBS PCR test at labor as outcome. The results of urine culture were used as exposure variable. The PCR test was performed on intrapartum vaginal samples. Results Screening for urine GBS in 902 unselected pregnant Danish women at 35–37 weeks of gestation predicted intrapartum PCR GBS status with a sensitivity of 33.6%. A positive predictive value of 41.2% was seen among women with low GBS counts (<104 CFU/mL) and 83.3% among women with high GBS counts (≥104 CFU/mL). Systematic GBS screening of urine at 35–37 weeks of gestation added 30.9% extra women for intrapartum GBS PCR screening in the study group. Conclusion Systematic antepartum GBS screening of urine should be implemented in order to improve risk stratification for early onset GBS by offering laboring women an intrapartum GBS PCR test.

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“…14 Although more evidence is needed, some other countries are exploring and advocating for alternatives to universal screening and treatment of asymptomatic bacteriuria, including expectant management and shared decision making. 15,16 A recent Cochrane review calls for more research to explore the cost-effectiveness of current screening and treatment guidelines and determine if certain defined low-risk groups may be unlikely to benefit from treatment of asymptomatic bacteriuria. 13 At present, there is insufficient evidence to determine the necessity or timing of repeat urine cultures for women who received treatment for asymptomatic bacteriuria.…”

Section: Figure 1 Screening and Management Of Group B Streptococcus mentioning

confidence: 99%

“…Previously, the USPSTF considered screening for asymptomatic bacteriuria in pregnancy an A‐grade recommendation but downgraded it to B‐grade in September 2019 because of the diminished applicability of older studies, recent research demonstrating a reduced risk of pyelonephritis, and rising concerns about antimicrobial resistance and adverse effects of antibiotics on the microbiome . Although more evidence is needed, some other countries are exploring and advocating for alternatives to universal screening and treatment of asymptomatic bacteriuria, including expectant management and shared decision making . A recent Cochrane review calls for more research to explore the cost‐effectiveness of current screening and treatment guidelines and determine if certain defined low‐risk groups may be unlikely to benefit from treatment of asymptomatic bacteriuria …”

Section: Current Evidence‐based Practice Recommendationsmentioning

confidence: 99%

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence‐Based, Patient‐Centered Approach to Care

Schafer

Phillippi

2020

J Midwife Womens Health

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Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS‐related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline‐based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence‐based, patient‐centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.

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Recommendations on screening for asymptomatic bacteriuria in pregnancy

Cited by 48 publications

References 20 publications

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35–37 weeks of pregnancy

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence‐Based, Patient‐Centered Approach to Care

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