Screening for Asymptomatic Bacteriuria in Adults

Henderson, Jillian T.; Webber, Elizabeth M.; Bean, Sarah

doi:10.1001/jama.2019.10060

Cited by 29 publications

(6 citation statements)

References 43 publications

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“…If they have asymptomatic bacteriuria, they will be treated with antibiotics. 26 At 16-22 weeks of gestation, asymptomatic women with twin pregnancies will undergo CL measurement and digital examination as part of routine clinical care. In case where vaginitis is suspected, vaginal culture could be performed.…”

Section: Methods and Analysis Study Design And Ethical Considerationsmentioning

confidence: 99%

Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix: study protocol for a two-by-two factorial randomised clinical trial

Dang¹,

Pham

et al. 2020

BMJ Open

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IntroductionWomen with twin pregnancies and a short cervix are at increased risk for preterm birth (PTB). Given the burden of prematurity and its attendant risks, the quest for effective interventions in twins has been an area of considerable research. Studies investigating the effectiveness of cervical cerclage, cervical pessary and vaginal progesterone in preventing PTB have yielded conflicting results. The aim of this study is to compare the effectiveness of cervical pessary and cervical cerclage with or without vaginal progesterone to prevent PTB in women with twin pregnancies and a cervical length (CL) ≤ 28 mm.Methods and analysisThis multicentre, randomised clinical trial will be conducted at My Duc Hospital and My Duc Phu Nhuan Hospital, Vietnam. Asymptomatic women with twin pregnancies and a CL ≤28 mm, measured at 16–22 weeks’ gestation, will be randomised in a 1:1:1:1 ratio to receive a cerclage, pessary, cerclage plus progesterone or pessary plus progesterone. Primary outcome will be PTB <34 weeks. Secondary outcomes will be maternal and neonatal complications. We preplanned a subgroup analysis according to CL from all women after randomisation and divided into four quartiles. Analysis will be conducted on an intention-to-treat basis. The rate of PTB <34 weeks’ gestation in women with twin pregnancies and a cervix ≤28 mm and treated with pessary in our previous study at My Duc Hospital was 24.2%. A sample size of 340 women will be required to show or refute that cervical cerclage decreases the rate of PTB <34 weeks by 50% compared with pessary (from 24.2% to 12.1%, α level 0.05, power 80%, 5% lost to follow-up and protocol deviation). This study is not to be powered to assess interactions between interventions.Ethics and disseminationEthical approval was obtained from the Institutional Ethics Committee of My Duc Hospital and informed patient consent was obtained before study enrolment. Results of the study will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03863613 (date of registration: 4 March 2019).

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Section: Methods and Analysis Study Design And Ethical Considerationsmentioning

confidence: 99%

Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix: study protocol for a two-by-two factorial randomised clinical trial

Dang¹,

Pham

et al. 2020

BMJ Open

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“…Multiple other societies, including the United States Preventive Services Task Force (USPSTF), the European Association of Urology (EAU), the American Academy of Family Physicians (AAFP), the Canadian Task Force on Preventive Health Care (CTFPHC), and the United Kingdom National Institute for Health and Care Excellence (NICE), also recommend screening pregnant women for ASB, although in recently updated guidelines, the USPSTF downgraded its recommendation from grade A to grade B (2,(8)(9)(10)(11). (For grade A, the USPSTF recommends this service with high certainty that the net benefit is substantial.…”

Section: Criteria For Asb Diagnosismentioning

confidence: 99%

“…For both grade A and grade B, the USPSTF suggestions for practice are to offer or provide the service). Guidelines from the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Scottish Intercollegiate Guidelines Network (SIGN) do not make specific recommendations for screening but support treatment for ASB in pregnant women (8,10,12). In addition to the IDSA, the EAU also supports screening patients for bacteriuria prior to urologic procedures associated with mucosal trauma (2).…”

Section: Criteria For Asb Diagnosismentioning

confidence: 99%

“…The best-documented consequence of untreated ASB in pregnant women is a significant risk of acute pyelonephritis, which can be life-threatening to both the mother and infant. The incidence of pyelonephritis associated with ASB in pregnancy was reported to be as high as 25 to 36% in older studies, and these older studies have informed guidelines, since few recent studies have been published (1,8).…”

Section: Pregnancymentioning

confidence: 99%

“…Given the currently available data, pregnancy remains one of the conditions in which screening and treatment for ASB is recommended by many medical societies to reduce the rate of pyelonephritis and its complications. The IDSA, ACOG, and AAP recommend screening with urine culture early in pregnancy, whereas the USPTF and AAFP recommend screening at 12 to 16 weeks of gestation or at the first prenatal visit if it occurs later than 12 to 16 weeks (1,8,9).…”

Section: Pregnancymentioning

confidence: 99%

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Targeting Asymptomatic Bacteriuria in Antimicrobial Stewardship: the Role of the Microbiology Laboratory

2020

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This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥105 CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥105 CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥105 CFU/ml in either women or men (or ≥102 CFU/ml of a single bacterial species from a single catheterized urine specimen). Any urine specimen with ≥104 CFU/ml group B Streptococcus is significant for asymptomatic bacteriuria in a pregnant woman. Asymptomatic bacteriuria occurs, irrespective of pyuria, in the absence of signs or symptoms of a urinary tract infection. The two groups with the best evidence of adverse outcomes in the setting of untreated asymptomatic bacteriuria include pregnant women and patients who undergo urologic procedures with risk of mucosal injury. Screening and treatment of asymptomatic bacteriuria is not recommended in the following patient populations: pediatric patients, healthy nonpregnant women, older patients in the inpatient or outpatient setting, diabetic patients, patients with an indwelling urethral catheter, patients with impaired voiding following spinal cord injury, patients undergoing nonurologic surgeries, and nonrenal solid-organ transplant recipients. Renal transplant recipients beyond 1 month posttransplant should not undergo screening and treatment for asymptomatic bacteriuria. There is insufficient evidence to recommend for or against screening of renal transplant recipients within 1 month, patients with high-risk neutropenia, or patients with indwelling catheters at the time of catheter removal. Unwarranted antibiotics place patients at increased risk of adverse effects (including Clostridioides difficile diarrhea) and contribute to antibiotic resistance. Methods to reduce unnecessary screening for and treatment of asymptomatic bacteriuria aid in antibiotic stewardship.

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Screening for Asymptomatic Bacteriuria in Adults

Owens

Davidson

Krist

et al. 2019

JAMA

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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)

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Screening for Asymptomatic Bacteriuria in Adults

Cited by 29 publications

References 43 publications

Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix: study protocol for a two-by-two factorial randomised clinical trial

Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix: study protocol for a two-by-two factorial randomised clinical trial

Targeting Asymptomatic Bacteriuria in Antimicrobial Stewardship: the Role of the Microbiology Laboratory

Screening for Asymptomatic Bacteriuria in Adults

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