Unmet need of antenatal screening for asymptomatic bacteriuria: A risk factor for adverse outcomes of pregnancy

Abstract

Recommended urine culture is unsuitable for screening pregnant women for asymptomatic bacteriuria due to long turn-around time, unaffordability, and user-unfriendliness. The objective of this review was to evaluate the suitability of various tests for this purpose. A PubMed-based systematic review of published articles irrespective of year and language was done. Search terms included asymptomatic bacteriuria, screening test, urinary tract infection, and diagnostic test. Diagnostic accuracy studies conducted on human populations comparing tests with urine culture were included. One author extracted predefined data fields, including quality indicators, another validated it. Of 78 records, 25 studies describing 15 tests were included. All tests were rapid, seven were valid and two of them were affordable and easy-to-use. No test provided comprehensive identification with antibiotic susceptibility. Despite publication bias, no test was found suitable for screening asymptomatic bacteriuria antenatally and providing evidence-based prescription. Further research is needed to develop tests which suit this purpose.

Effectiveness of antenatal screening of asymptomatic bacteriuria in reduction of prematurity and low birth weight: Evaluating a point-of-care rapid test in a pragmatic randomized controlled study

“…Most pregnant women in low-and middle-income countries (LMIC) like India attend antenatal check-ups in low resource healthcare facilities in rural areas, which suffer from wide disparity in availability and accessibility to health infrastructure and diagnostic testing facilities, and fail to provide screening for ASB as per the recommendations [14,15]. Conventional urine culture is not suitable for this purpose considering the need for specific resources, dedicated infrastructure, trained personnel, and long turnaround time [16]. USPSTF suggested to develop a new technology for rapid screening to reduce the dependence on conventional urine culture and improve the outcomes of such pregnancies [13].…”

Effect of asymptomatic bacteriuria on pregnancy outcome: a review

“…Complications in neonate such as prematurity, low birth weight, IUGR, perinatal mortality and morbidity. 1 Various explanations for the association of pyelonephritis and preterm labour include: Myometrial activity is increased due to pyrogens Gram negative bacteria produces endotoxins which has an oxytocic effect on cells of myometrium.…”

“…During pregnancy, women have more chances to acquire asymptomatic bacteriuria due to the physiological and morphological changes occurring in them and also due to the immune-compromised status of the pregnant women. 1 ASB is more common in women due to short urethra and urethra is more proximal to the anal canal. Urinary tract infections can be symptomatic or asymptomatic.…”

Asymptomatic Bacteriuria, Prevalence Report during Antenatal Period at Pumhsw Nawabshah, Pakistan

“…ASB is defined as the presence of bacterial organisms more than 10 [5] per ml of urine, in a midstream of properly collected urine sample, without symptoms organisms, with a positive urine culture growth [11]. There is increasing the risk of ASB and symptomatic bacteriuria in pregnancy due to several hormonal and anatomical changes such as pressure of gravid uterus on ureters and urinary bladder which causes bacteriuria due to stasis of urine and reduced immunity [12]. Silent antenatal asymptomatic bacteriuria if not treated timely may progress to severe adverse obstetric and renal outcomes [13].…”