Screening for Asymptomatic Bacteriuria in Adults

Abstract

IMPORTANCE Among the general adult population, women (across all ages) have the highest prevalence of asymptomatic bacteriuria, although rates increase with age among both men and women. Asymptomatic bacteriuria is present in an estimated 1% to 6% of premenopausal women and an estimated 2% to 10% of pregnant women and is associated with pyelonephritis, one of the most common nonobstetric reasons for hospitalization in pregnant women. Among pregnant persons, pyelonephritis is associated with perinatal complications including septicemia, respiratory distress, low birth weight, and spontaneous preterm birth. OBJECTIVE To update its 2008 recommendation, the USPSTF commissioned a review of the evidence on potential benefits and harms of screening for and treatment of asymptomatic bacteriuria in adults, including pregnant persons. POPULATION This recommendation applies to community-dwelling adults 18 years and older and pregnant persons of any age without signs and symptoms of a urinary tract infection. EVIDENCE ASSESSMENT Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in pregnant persons has moderate net benefit in reducing perinatal complications. There is adequate evidence that pyelonephritis in pregnancy is associated with negative maternal outcomes and that treatment of screen-detected asymptomatic bacteriuria can reduce the incidence of pyelonephritis in pregnant persons. The USPSTF found adequate evidence of harms associated with treatment of asymptomatic bacteriuria (including adverse effects of antibiotic treatment and changes in the microbiome) to be at least small in magnitude. The USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in nonpregnant adults has no net benefit. The known harms associated with treatment include adverse effects of antibiotic use and changes to the microbiome. Based on these known harms, the USPSTF determined the overall harms to be at least small in this group. RECOMMENDATIONS The USPSTF recommends screening pregnant persons for asymptomatic bacteriuria using urine culture. (B recommendation) The USPSTF recommends against screening for asymptomatic bacteriuria in nonpregnant adults. (D recommendation)

Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda

“…There is a debate on whether treatment of ASBP improves neonatal outcomes and whether antibiotic treatment is associated with adverse pregnancy outcomes. However, there is insufficient evidence to support these associations [8,9]. It is important therefore to screen pregnant women and offer treatment to mothers diagnosed with ASBP.…”

Assessment of Prevalence and Cost of Care Cascades After Routine Testing During the Medicare Annual Wellness Visit

“…Conversely, some patients may receive their routine testing during other visits, which would bias our results to the null, although we address this point by excluding patients who had an index test in the past 6 months. In addition, we note that, while some cascades captured in this study may have contributed to improved health, there is clear evidence codified in society recommendations that, on average, these routine tests offer little benefit and the potential for harms …”

“…We defined cascade events as follow-up services and new diagnoses that would plausibly follow from the index event and could be captured reliably in claims data. Using prior literature, guidelines, and clinical knowledge, 2 internal medicine physicians/health services researchers (I.G. and T.D.S.)…”

“…For healthy adults, routine testing during annual check-ups is considered to be of low value . Organizations such as the United States Preventive Services Task Force and the Choosing Wisely campaign advise against routine electrocardiograms (ECGs), urinalyses, and thyrotropin tests (eAppendix 1 in the Supplement). While US studies from the 1990s and 2000s suggest that these tests were commonly performed and favored by physicians, we do not have more recent estimates.…”

A global perspective on management of bacterial infections in pregnancy: a systematic review of international guidelines

“…Two guidelines, produced on behalf of the United States Preventive Task Force (USPTF) [10] and SOGC [11] discussed this topic (Tables 1 & 2). There was concordance between the two guidelines regarding universal screening for asymptomatic bacteriuria in pregnancy using mid-stream urine cultures.…”