Recommendation Statement
This statement summarizes the current U.S. Preventive Services
Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria,
and updates the 1996 recommendation contained in the Guide to Clinical Preventive
Services, Second Edition.1
Summary of Recommendations
- The U.S. Preventive Services Task Force strongly recommends that all
pregnant women be screened for asymptomatic bacteriuria using urine
culture at 12-16 weeks' gestation.
Rating: A Recommendation. Rationale: The USPSTF found good evidence that screening
pregnant women for asymptomatic bacteriuria with urine culture significantly
reduces symptomatic urinary tract infections, low birth weight, and
preterm delivery. The benefits of screening and treatment substantially
outweigh any potential harms.
- The USPSTF recommends against the routine screening of men and nonpregnant
women for asymptomatic bacteriuria.
Rating: D Recommendation.
Rationale: The USPSTF found fair evidence that screening men
and non-pregnant women for asymptomatic bacteriuria is ineffective
in improving clinical outcomes. In the absence of evidence of benefit,
the potential harms associated with overuse of antibiotics are especially
significant.
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Contents
Background
Clinical Considerations
References
Members of the Task Force
Contact the Task Force
Available Products
Copyright and Source Information
Background
The U.S. Preventive Services Task Force (USPSTF) last addressed screening
for asymptomatic bacteriuria in the 1996 Guide to Clinical Preventive Services and
made the following recommendations: All pregnant women should be screened for
asymptomatic bacteriuria using urine culture at 12-16 weeks’ gestation
(A recommendation). Routine
screening of pregnant women using leukocyte esterase or nitrite testing was
not recommended because of poor test characteristics
compared with urine culture (D
recommendation).1 There
was insufficient evidence to recommend for or against routine screening of
ambulatory elderly women or
women with diabetes using leukocyte esterase or nitrite testing (C
recommendation).1
Routine screening for asymptomatic bacteriuria using leukocyte esterase or
nitrite testing was not recommended for other asymptomatic persons, including
school-aged girls (E recommendation),
the institutionalized elderly (E recommendation), and other children, adolescents,
and adults (D
recommendation).1 Screening
for asymptomatic bacteriuria with microscopy testing was not recommended (D
recommendation).1
Since then, the USPSTF criteria to rate the strength of the evidence have
changed. Therefore, the recommendation statement that follows has been updated
and revised based on the current USPSTF methodology and rating of the strength
of the evidence2. Explanations of the current
USPSTF ratings and of the strength of overall evidence are given in Appendix
A and Appendix B,
respectively. This
recommendation statement and the brief update, Screening for Asymptomatic
Bacteriuria,3 are available through
the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and through the National
Guideline Clearinghouse™ (http://www.guideline.gov).
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Clinical Considerations
- 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. Urine culture is the
gold standard for detecting asymptomatic bacteriuria but is expensive for routine
screening in populations with a low prevalence of this condition. Results from
one study done with a new enzymatic urine-screening test (Uriscreen™) showed
that the test has a sensitivity of 100 percent and a specificity of 81 percent.
- Good evidence exists that screening pregnant women for asymptomatic
bacteriuria with urine culture (rather than urinalysis) significantly reduces
symptomatic urinary tract infections, low birth weight, and preterm delivery.
A specimen obtained at 12-16 weeks’ gestation will detect approximately
80 percent of patients with asymptomatic bacteriuria. The optimal frequency
of subsequent
urine testing during pregnancy is uncertain.
- Good evidence exists that screening individuals other than pregnant
women for asymptomatic bacteriuria does not significantly improve clinical
outcomes. Results from a study of women with diabetes who were treated for
asymptomatic bacteriuria demonstrated no reduction in complications.4 Although
there were short-term results in clearing bacteriuria with antimicrobial therapy,
there was no decrease in the number of symptomatic episodes or hospitalizations
over the long term. Furthermore, the high rate of recurrence of bacteriuria
in those who were screened and treated resulted in a marked increase in the
use of antimicrobial agents.
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References
1. U.S. Preventive Services Task Force; Guide to Clinical
Preventive Services, 2nd ed. Washington, DC: Office of Disease Prevention
and Health Promotion, 1996.
2. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch
SM, Atkins D, for the Methods Word Group, third U.S. Preventive Services Task
Force. Current methods of the U.S. Preventive Services Task Force: a review
of the process. Am J Prev Med 2001;20(3S):21-35.
3. Screening for asymptomatic bacteriuria: a brief evidence
update for the U.S Preventive Services Task Force. Agency for Healthcare Research
and Quality. 2004. Available at http://www.preventiveservices.ahrq.gov.
4. Harding GKM, Zhanel GG, Nicolle LE, Cheang M. Antimicrobial
treatment in diabetic women with asymptomatic bacteriuria. N Engl J Med 2002;
347(20):1576-83.
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Members of the Task Force
Members of the U.S. Preventive Services Task Force* are are Alfred O. Berg, M.D., M.P.H., Chair, USPSTF (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, Ph.D., R.N., C.S., Vice-chair, USPSTF (Dean, School of Nursing, University of Maryland Baltimore, Baltimore, MD); Ned Calonge, M.D., M.P.H. (Acting Chief Medical Officer, Colorado Department of Public Health and Environment, Denver, CO); Paul Frame, M.D. (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Joxel Garcia, M.D., M.B.A. (Deputy Director, Pan American Health Organization, Washington, DC); Russell Harris, M.D., M.P.H. (Associate Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); Mark S. Johnson, M.D., M.P.H. (Professor of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, M.D., M.P.H. (Associate Professor, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY); Carol Loveland-Cherry, Ph.D., R.N. (Executive Associate Dean, School of Nursing, University of Michigan, Ann Arbor, MI); Virginia A. Moyer, M.D., M.P.H. (Professor, Department of Pediatrics, University of Texas at Houston, Houston, TX); C. Tracy Orleans, Ph.D. (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Albert L. Siu, M.D., M.S.P.H. (Professor of Medicine, Chief of Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY); Steven M. Teutsch, M.D., M.P.H. (Senior Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, M.D., M.Sc. (Professor of Obstetrics and Gynecology and Professor of Public Health, Columbia University, New York, NY); and Steven H. Woolf, M.D., M.P.H. (Professor, Department of Family Practice and Department of Preventive and Community Medicine and Director of Research Department of Family Practice, Virginia Commonwealth University, Fairfax, VA).
* Member of the USPSTF at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
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Contact the Task Force
Address correspondence to: Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive
Services Task Force; c/o Program Director, USPSTF; 540 Gaither Road; Rockville,
MD 20850; E-mail: info@ahrq.gov.
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Available Products
This recommendation statement and the brief update, Screening for Asymptomatic
Bacteriuria: Brief Evidence Update for the U.S. Preventive Services Task Force,3
are available on the USPSTF Web site at http://www.preventiveservices.ahrq.gov.
Individual copies of this statement are available online through the National
Guideline Clearinghouse™ at: http://www.guideline.gov.
The summary of the evidence and the recommendation statement are also available in print by subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates.
Recommendations made by the USPSTF are independent of the U.S. Government.
They should not be construed as an official position of AHRQ or the U.S. Department
of Health and Human Services.
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Copyright and Electronic Dissemination
This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Requests for linking or to incorporate content in electronic resources should be sent to: info@ahrq.gov.
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Current as of February 2004
Internet Citation:
U.S. Preventive Services Task Force. Screening for Asymptomatic Bacteriuria: Recommendation Statement. February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/asymbac/asymbacrs.htm
540 Gaither Road Rockville, MD 20850