USPSTF Continues to Advise Screening for Asymptomatic Bacteriuria in Pregnant Women

By Megan Brooks

September 26, 2019

NEW YORK (Reuters Health) - The U.S. Preventive Services Task Force (USPSTF) continues to recommend screening for asymptomatic bacteriuria in pregnant women with urine culture and discourage such screening in nonpregnant adults, based on an updated systematic review of the evidence.

Asymptomatic bacteriuria occurs in up to 10% of pregnant women and is associated with pyelonephritis, "which can cause permanent damage to the kidneys, it can lead to preterm birth and can even be life-threatening for the mother and the unborn child," task force member Dr. Melissa Simon of Northwestern Medicine in Chicago said in a podcast.

The updated USPSTF guidance on screening for asymptomatic bacteriuria (ASB), published online today in JAMA along with the updated evidence report, is not substantively changed from the previous guidance released in 2008.

It reaffirms the prior recommendation to screen pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit for ASB. However, the certainty of evidence has been changed to moderate (B grade) from high certainty (A grade) in the previous guideline.

"The uncertainty reflects some of the angst that we all have about use of antibiotics and the growing resistance of organisms and our awareness of the importance of the microbiome and antibiotics do change it," task force member Dr. Chyke Doubeni of the University of Pennsylvania Perelman School of Medicine, in Philadelphia, told Reuters Health by phone.

"Recent studies also suggest that the incidence or prevalence of asymptomatic bacteriuria is actually getting lower. All this combined decrease the level of certainty, or confidence, in the much older evidence that we have to use for the recommendation," he said.

Dr. Doubeni emphasized, however, that the change in letter grade from A to B does not change the recommendation. "It still means that clinicians should be performing routine screening of pregnant persons. It's just a difference in the level of certainty that we have on the evidence," he said.

Despite this change, screening of pregnant women for ASB has "remained engrained in practice across most institutions for more than 2 decades and is likely to continue," write Dr. Jerome Leis and Christine Soong of the University of Toronto in Canada in a linked editorial in JAMA Internal Medicine.

The task force found no new evidence to alter its recommendation not to screen for ASB among healthy, nonpregnant adults.

Not screening or treating ASB in this population has long been "an ironclad recommendation endorsed by the Infectious Diseases Society of America, as well as numerous professional societies as part of the Choosing Wisely campaign," write Drs. Leis and Soong. "Restating this steadfast and pervasive recommendation may seem unremarkable and almost pedantic, yet it remains stubbornly disregarded by clinicians across multiple settings."

"I wish people would just listen to us and stop doing it because this is one place that clearly contributes to unnecessary use of antibiotics," Dr. Doubeni told Reuters Health.

SOURCES: http://bit.ly/2mkuLEJ

JAMA 2019.

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