Screening for Asymptomatic Bacteriuria in Adults: U.S. Preventive Services Task Force Recommendations

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Screening for Asymptomatic Bacteriuria in Adults: U.S.
Preventive Services Task Force Recommendations

Who developed these guidelines?
The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that makes
recommendations about preventive health care.
What is the problem and what is known about it so far?
Bacteriuria refers to bacteria in the urine. When bacteria get into the urine, a urinary tract
infection (UTI) (also called bladder or kidney infection) can occur. The symptoms of UTIs
include painful and frequent urination, fever, and pain in the lower abdomen or back.
However, sometimes people have asymptomatic bacteriuria. This means that they have no
symptoms even though they have bacteria in their urine.
Urinary tract infections are usually easy to treat with antibiotics, but sometimes
serious complications can occur, including kidney damage or spread of the infection
through the bloodstream. Urinary tract infections in pregnant women can lead to
problems for both the mother and the fetus. Because UTIs can be uncomfortable, have
serious health effects, and are easy to treat, it might make sense to test for bacteriuria
even if patients have no symptoms. This would allow physicians to treat patients with
antibiotics before symptoms or complications happen. Looking for a disease in people
with no symptoms is called screening. To test for bacteriuria, a sample of urine is collected
and sent to the laboratory.
In 2004, the USPSTF recommended against screening adults for asymptomatic
bacteriuria, except for pregnant women. The Task Force wanted to see whether studies
published since 2004 should lead to changes in this recommendation.
How did the USPSTF develop these recommendations?
The USPSTF reviewed research published since their 2004 recommendation on screening
for asymptomatic bacteriuria to look at the benefits and harms of screening.
What did the authors find?
They found strong evidence that identifying and treating pregnant women with
asymptomatic bacteriuria with antibiotics reduces UTIs in the mothers and low
birthweight in the babies. They found adequate evidence that identifying and treating
nonpregnant adults with asymptomatic bacteriuria does not improve outcomes. The
potential harm associated with screening is that it might lead to the use of antibiotics in
people who might have been fine without treatment. This would needlessly expose people
to possible antibiotic side effects.
What does the USPSTF suggest that doctors and patients do?
The USPSTF recommends that all pregnant women receive a urine culture at 12 to 16
weeks or their first prenatal visit, if later than 12 to 16 weeks. The USPSTF recommends
no screening for bacteriuria in nonpregnant patients with no UTI symptoms.
What are the cautions related to these recommendations?
The recommendations may change as new studies become available. However, the
USPSTF has judged that it would take large, high-quality studies to overturn these
recommendations.