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USPSTF: Screen pregnant women for asymptomatic bacteriuria
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Pregnant women should be screened for asymptomatic bacteriuria using a urine culture, according to a U.S. Preventive Services Task Force recommendation statement published in JAMA.
The task force recommended against screening for all other asymptomatic adults.
Melissa Simon, MD, task force member and vice chair for clinical research in the department of obstetrics and gynecology at Northwestern University, explained why it is so important for health care providers to screen pregnant women for asymptomatic bacteriuria.
“Women who are pregnant are at increased risk for having a more severe UTI that can lead to a bad kidney infection or pyelonephritis, hence the B grade recommendation,” she told Healio Primary Care, adding that screening for asymptomatic bacteriuria is part of “routine care in the perinatal world.”
In 2008, the USPSTF issued an A grade recommendation that pregnant women at 12 to 16 weeks’ gestation or at their first prenatal visit should be screened for asymptomatic bacteriuria. Simon explained why the grade changed.
“The balance of benefits and harms has shifted,” she said in the interview. “The evidence shows the risk of pyelonephritis, or a very serious kidney infection, has gone down for pregnant patients. There is also greater concern around use of antibiotics, antibiotic resistance, and maintaining good bacteria in the body than before. The task force is calling for more research in this area, as it is an important potential harm to consider.”
The risk for antibiotic resistance is also part of the rationale behind USPSTF’s recommendation against screening for asymptomatic bacteriuria in all other adults, according to Simon.
“The overuse of antibiotics in these patients can also cause harm, such as resistance in treating bona fide infections, and is cause for great concern,” she said. “Since we don’t have enough evidence to override those concerns when it comes to adults with asymptomatic bacteriuria, the task force gave this recommendation a D level grade.”
The new USPSTF recommendations are helpful but leave some questions unanswered, Lindsay E. Nicolle, MD, FRCPC, of the department of internal medicine at the University of Manitoba in Canada, wrote in a related editorial.
“Questions remain about the risks and benefits of universal screening for and treatment of asymptomatic bacteriuria in pregnant women in the context of current clinical practice,” she wrote. “The effects of changes in fetal maternal care, of low- compared with high-risk pregnancies, and of health care access need to be understood.”
Until answers are found, she said conducting a second urine culture “may provide an immediate opportunity to limit unnecessary antimicrobial use for some pregnant women.”
Earlier this year, the Infectious Diseases Society of America updated its clinical practice guidelines for the management of asymptomatic bacteriuria for the first time since 2005. The society added infants and children, people who have had joint replacement or other nonurologic surgery, and people who have had organ transplants to the list of patients who should not be tested for a UTI without experiencing other symptoms. – by Janel Miller
References:
Henderson JT, et al. JAMA. 2019;doi:10.1001/jama.2019.10060.
Nicolle LE. JAMA. 2019;doi:10.1001/jama.2019.11640.
U.S. Preventive Services Task Force. JAMA. 2019;doi:10.1001/jama.2019.13069.
Disclosures: Neither Simon nor Nicolle report any relevant financial disclosures. Please see the recommendation statement for all authors’ relevant financial disclosures.