U.S. Preventive Services Task Force

Screening for Asymptomatic Bacteriuria in Adults: Reaffirmation Recommendation Statement



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Summary of Recommendations and Evidence

The U.S. Preventive Services Task Force (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 (Table 1). A recommendation.

The USPSTF recommends against screening for asymptomatic bacteriuria in men and nonpregnant women. D recommendation.

Table 1.

Screening for Asymptomatic Bacteriuria in Adults: Clinical Summary of the USPSTF Recommendation

Population

All pregnant women

Men and nonpregnant women

Recommendation

Screen with urine culture

Do not screen

Grade: A

Grade: D

Detection and screening tests

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, in a midstream clean-catch specimen, is considered a positive test result.

Screening intervals

A clean-catch urine specimen should be collected for screening culture at 12 to 16 weeks' gestation or at the first prenatal visit, if later.

Do not screen.

The optimal frequency of subsequent urine testing during pregnancy is uncertain.

Benefits of detection and early treatment

The detection and treatment of asymptomatic bacteriuria with antibiotics significantly reduces the incidence of symptomatic maternal urinary tract infections and low birth weight.

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 of asymptomatic bacteriuria include adverse effects from antibiotics and the development of bacterial resistance.

Other relevant recommendations from the USPSTF

Additional USPSTF recommendations involving screening for infectious conditions during pregnancy can be found at http://www.ahrq.gov/clinic/cps3dix.htm#obstetric and http://www.ahrq.gov/clinic/cps3dix.htm#infectious.


NOTE: For the full recommendation statement and supporting documents, visit http://www.uspreventiveservicestaskforce.org/recommendations.htm.

USPSTF = U.S. Preventive Services Task Force.

Table 1.   Screening for Asymptomatic Bacteriuria in Adults: Clinical Summary of the USPSTF Recommendation

View Table

Table 1.

Screening for Asymptomatic Bacteriuria in Adults: Clinical Summary of the USPSTF Recommendation

Population

All pregnant women

Men and nonpregnant women

Recommendation

Screen with urine culture

Do not screen

Grade: A

Grade: D

Detection and screening tests

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, in a midstream clean-catch specimen, is considered a positive test result.

Screening intervals

A clean-catch urine specimen should be collected for screening culture at 12 to 16 weeks' gestation or at the first prenatal visit, if later.

Do not screen.

The optimal frequency of subsequent urine testing during pregnancy is uncertain.

Benefits of detection and early treatment

The detection and treatment of asymptomatic bacteriuria with antibiotics significantly reduces the incidence of symptomatic maternal urinary tract infections and low birth weight.

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 of asymptomatic bacteriuria include adverse effects from antibiotics and the development of bacterial resistance.

Other relevant recommendations from the USPSTF

Additional USPSTF recommendations involving screening for infectious conditions during pregnancy can be found at http://www.ahrq.gov/clinic/cps3dix.htm#obstetric and http://www.ahrq.gov/clinic/cps3dix.htm#infectious.


NOTE: For the full recommendation statement and supporting documents, visit http://www.uspreventiveservicestaskforce.org/recommendations.htm.

USPSTF = U.S. Preventive Services Task Force.

Rationale

Importance. In pregnant women, asymptomatic bacteriuria has been associated with an increased incidence of pyelonephritis and low birth weight (less than 2,500 g [5 lb, 8 oz]).

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, 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 (UTIs) and low birth weight.

In men and nonpregnant women, adequate evidence suggests that screening men and non-pregnant 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.

Clinical Considerations

  • Patient population. This recommendation applies to the general adult population, including adults with diabetes mellitus. The USPSTF did not review evidence for screening certain groups at high risk of severe UTIs, such as transplant recipients, patients with sickle cell disease, and patients with recurrent UTIs.

  • 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 standard criterion 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 urinary specimen for a screening culture at 12 to 16 weeks' gestation or at the first pre-natal visit, if later. The optimal frequency of subsequent urine testing during pregnancy is uncertain.


This recommendation statement was first published in Ann Intern Med. 2008;149(1):43–47.

The “Other Considerations,” “Discussion,” and “Recommendations of Others” sections of this recommendation statement are available at http://www.ahrq.gov/clinic/uspstf/uspsbact.htm.

The U.S. Preventive Services Task Force recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

REFERENCES

1. Screening for asymptomatic bacteriuria. In: US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Rockville, Md.: Agency for Healthcare Research and Quality; 1996:347–359.

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(1):W20–W24.

This summary is one in a series excerpted from the Recommendation Statements released by the U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and preventive medications.

A collection of USPSTF recommendation statements reprinted in AFP is available at http://www.aafp.org/afp/uspstf.

The complete version of this statement, including supporting scientific evidence, evidence tables, grading system, members of the USPSTF at the time this recommendation was finalized, and references, is available on the USPSTF Web site at http://www.ahrq.gov/clinic/uspstf/uspsbact.htm.



Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

More in Pubmed

Navigate this Article