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Screening for Asymptomatic Bacteriuria in AdultsUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the US Preventive Services Task Force (USPSTF) recommendations regarding screening for asymptomatic bacteriuria in adults.
1 Credit CME

Importance  Among the general adult population, women (across all ages) have the highest prevalence of asymptomatic bacteriuria, although rates increase with age among both men and women. Asymptomatic bacteriuria is present in an estimated 1% to 6% of premenopausal women and an estimated 2% to 10% of pregnant women and is associated with pyelonephritis, one of the most common nonobstetric reasons for hospitalization in pregnant women. Among pregnant persons, pyelonephritis is associated with perinatal complications including septicemia, respiratory distress, low birth weight, and spontaneous preterm birth.

Objective  To update its 2008 recommendation, the USPSTF commissioned a review of the evidence on potential benefits and harms of screening for and treatment of asymptomatic bacteriuria in adults, including pregnant persons.

Population  This recommendation applies to community-dwelling adults 18 years and older and pregnant persons of any age without signs and symptoms of a urinary tract infection.

Evidence Assessment  Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in pregnant persons has moderate net benefit in reducing perinatal complications. There is adequate evidence that pyelonephritis in pregnancy is associated with negative maternal outcomes and that treatment of screen-detected asymptomatic bacteriuria can reduce the incidence of pyelonephritis in pregnant persons. The USPSTF found adequate evidence of harms associated with treatment of asymptomatic bacteriuria (including adverse effects of antibiotic treatment and changes in the microbiome) to be at least small in magnitude. The USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in nonpregnant adults has no net benefit. The known harms associated with treatment include adverse effects of antibiotic use and changes to the microbiome. Based on these known harms, the USPSTF determined the overall harms to be at least small in this group.

Recommendations  The USPSTF recommends screening pregnant persons for asymptomatic bacteriuria using urine culture. (B recommendation) The USPSTF recommends against screening for asymptomatic bacteriuria in nonpregnant adults. (D recommendation)

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Article Information

Corresponding Author: Douglas K. Owens, MD, MS, Stanford University, 616 Serra St, Encina Hall, Room C336, Stanford, CA 94305-6019 (chair@uspstf.net).

Correction: This article was corrected on October 11, 2019, for incorrect information in an author affiliation.

Accepted for Publication: August 8, 2019.

The US Preventive Services Task Force (USPSTF) members: Douglas K. Owens, MD, MS; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Owens); Stanford University, Stanford, California (Owens); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); Temple University, Philadelphia, Pennsylvania (Kubik); University of Alabama at Birmingham (Landefeld); University of California, Los Angeles (Mangione); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Owens had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. Dr Barry reported receiving grants and personal fees from Healthwise, a nonprofit, outside the submitted work. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. No other disclosures were reported.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Justin Mills, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Foxman  B.  Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden.  Infect Dis Clin North Am. 2014;28(1):1-13. doi:10.1016/j.idc.2013.09.003PubMedGoogle ScholarCrossref
Henderson  J, Webber  E, Bean  S.  Screening for Asymptomatic Bacteriuria in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2019.
Hooton  TM, Scholes  D, Stapleton  AE,  et al.  A prospective study of asymptomatic bacteriuria in sexually active young women.  N Engl J Med. 2000;343(14):992-997. doi:10.1056/NEJM200010053431402PubMedGoogle ScholarCrossref
Ferroni  M, Taylor  AK.  Asymptomatic bacteriuria in noncatheterized adults.  Urol Clin North Am. 2015;42(4):537-545. doi:10.1016/j.ucl.2015.07.003PubMedGoogle ScholarCrossref
Schnarr  J, Smaill  F.  Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy.  Eur J Clin Invest. 2008;38(suppl 2):50-57. doi:10.1111/j.1365-2362.2008.02009.xPubMedGoogle ScholarCrossref
Nicolle  LE, Bradley  S, Colgan  R, Rice  JC, Schaeffer  A, Hooton  TM; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society.  Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.  Clin Infect Dis. 2005;40(5):643-654. doi:10.1086/427507PubMedGoogle ScholarCrossref
Macejko  AM, Schaeffer  AJ.  Asymptomatic bacteriuria and symptomatic urinary tract infections during pregnancy.  Urol Clin North Am. 2007;34(1):35-42. doi:10.1016/j.ucl.2006.10.010PubMedGoogle ScholarCrossref
Hill  JB, Sheffield  JS, McIntire  DD, Wendel  GD  Jr.  Acute pyelonephritis in pregnancy.  Obstet Gynecol. 2005;105(1):18-23. doi:10.1097/01.AOG.0000149154.96285.a0PubMedGoogle ScholarCrossref
Wing  DA, Fassett  MJ, Getahun  D.  Acute pyelonephritis in pregnancy: an 18-year retrospective analysis.  Am J Obstet Gynecol. 2014;210(3):219.e1-219.e6. doi:10.1016/j.ajog.2013.10.006PubMedGoogle ScholarCrossref
Dull  RB, Friedman  SK, Risoldi  ZM, Rice  EC, Starlin  RC, Destache  CJ.  Antimicrobial treatment of asymptomatic bacteriuria in noncatheterized adults: a systematic review.  Pharmacotherapy. 2014;34(9):941-960. doi:10.1002/phar.1437PubMedGoogle ScholarCrossref
Glaser  AP, Schaeffer  AJ.  Urinary tract infection and bacteriuria in pregnancy.  Urol Clin North Am. 2015;42(4):547-560. doi:10.1016/j.ucl.2015.05.004PubMedGoogle ScholarCrossref
Juthani-Mehta  M.  Asymptomatic bacteriuria and urinary tract infection in older adults.  Clin Geriatr Med. 2007;23(3):585-594. doi:10.1016/j.cger.2007.03.001PubMedGoogle ScholarCrossref
Verani  J, McGee  L, Schrag  S.  Prevention of Preinatal Group B Streptococcal Disease. Atlanta, GA: Centers for Disease Control and Prevention; 2010.
US Preventive Services Task Force.  Guide to Clinical Preventive Services: Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. Baltimore, MD: Agency for Healthcare Research and Quality; 1996.
US Preventive Services Task Force.  Screening for Asymptomatic Bacteriuria: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
U.S. Preventive Services Task Force.  Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement.  Ann Intern Med. 2008;149(1):43-47. doi:10.7326/0003-4819-149-1-200807010-00009PubMedGoogle ScholarCrossref
Henderson  JT, Webber  EM, Bean  SI.  Screening for asymptomatic bacteriuria in adults: updated evidence report and systematic review for the US Preventive Services Task Force  [published September 24, 2019]. JAMA. doi:10.1001/jama.2019.10060
Uncu  Y, Uncu  G, Esmer  A, Bilgel  N.  Should asymptomatic bacteriuria be screened in pregnancy?  Clin Exp Obstet Gynecol. 2002;29(4):281-285.PubMedGoogle Scholar
Gratacós  E, Torres  PJ, Vila  J, Alonso  PL, Cararach  V.  Screening and treatment of asymptomatic bacteriuria in pregnancy prevent pyelonephritis.  J Infect Dis. 1994;169(6):1390-1392. doi:10.1093/infdis/169.6.1390PubMedGoogle ScholarCrossref
Wren  BG.  Subclinical renal infection and prematurity.  Med J Aust. 1969;2(12):596-600.PubMedGoogle ScholarCrossref
Williams  GL, Campbell  H, Davies  KJ.  Urinary concentrating ability in women with asymptomatic bacteriuria in pregnancy.  Br Med J. 1969;3(5664):212-215. doi:10.1136/bmj.3.5664.212PubMedGoogle ScholarCrossref
Furness  ET, McDonald  PJ, Beasley  NV.  Urinary antiseptics in asymptomatic bacteriuria of pregnancy.  N Z Med J. 1975;81(539):417-419.PubMedGoogle Scholar
Elder  HA, Santamarina  BA, Smith  S, Kass  EH.  The natural history of asymptomatic bacteriuria during pregnancy: the effect of tetracycline on the clinical course and the outcome of pregnancy.  Am J Obstet Gynecol. 1971;111(3):441-462. doi:10.1016/0002-9378(71)90793-9PubMedGoogle ScholarCrossref
Little  PJ.  The incidence of urinary infection in 5000 pregnant women.  Lancet. 1966;2(7470):925-928. doi:10.1016/S0140-6736(66)90534-4PubMedGoogle ScholarCrossref
Foley  ME, Farquharson  R, Stronge  JM.  Is screening for bacteriuria in pregnancy worthwhile?  Br Med J (Clin Res Ed). 1987;295(6592):270. doi:10.1136/bmj.295.6592.270PubMedGoogle ScholarCrossref
Pathak  UN, Tang  K, Williams  LL, Stuart  KL.  Bacteriuria of pregnancy: results of treatment.  J Infect Dis. 1969;120(1):91-103. doi:10.1093/infdis/120.1.91PubMedGoogle ScholarCrossref
Kincaid-Smith  P, Bullen  M.  Bacteriuria in pregnancy.  Lancet. 1965;1(7382):395-399. doi:10.1016/S0140-6736(65)90001-2PubMedGoogle ScholarCrossref
Savage  WE, Hajj  SN, Kass  EH.  Demographic and prognostic characteristics of bacteriuria in pregnancy.  Medicine (Baltimore). 1967;46(5):385-407. doi:10.1097/00005792-196709000-00002PubMedGoogle ScholarCrossref
Gold  EM, Traub  FB, Daichman  I, Terris  M.  Asymptomatic bacteriuria during pregnancy.  Obstet Gynecol. 1966;27(2):206-209.PubMedGoogle Scholar
Brumfitt  W.  The effects of bacteriuria in pregnancy on maternal and fetal health.  Kidney Int Suppl. 1975;4:S113-S119.PubMedGoogle Scholar
Kazemier  BM, Koningstein  FN, Schneeberger  C,  et al.  Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial.  Lancet Infect Dis. 2015;15(11):1324-1333. doi:10.1016/S1473-3099(15)00070-5PubMedGoogle ScholarCrossref
Giamarellou  H, Dontas  A, Zorbas  P, Staszewska-Pistoni  M, Xirouchaki  E, Petrikkos  G.  Asymptomatic bacteriuria in freely voiding elderly subjects: long-term continuous vs pulse treatment with ofloxacin.  Clin Drug Investig. 1998;15(3):187-195. doi:10.2165/00044011-199815030-00003PubMedGoogle ScholarCrossref
Abrutyn  E, Mossey  J, Berlin  JA,  et al.  Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women?  [published correction appears in Ann Intern Med. 1994;121(11):901].  Ann Intern Med. 1994;120(10):827-833. doi:10.7326/0003-4819-120-10-199405150-00003PubMedGoogle ScholarCrossref
Asscher  AW, Sussman  M, Waters  WE,  et al.  The clinical significance of asymptomatic bacteriuria in the nonpregnant woman.  J Infect Dis. 1969;120(1):17-26. doi:10.1093/infdis/120.1.17PubMedGoogle ScholarCrossref
Boscia  JA, Kobasa  WD, Knight  RA, Abrutyn  E, Levison  ME, Kaye  D.  Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women.  JAMA. 1987;257(8):1067-1071. doi:10.1001/jama.1987.03390080057030PubMedGoogle ScholarCrossref
Harding  GK, Zhanel  GG, Nicolle  LE, Cheang  M; Manitoba Diabetes Urinary Tract Infection Study Group.  Antimicrobial treatment in diabetic women with asymptomatic bacteriuria.  N Engl J Med. 2002;347(20):1576-1583. doi:10.1056/NEJMoa021042PubMedGoogle ScholarCrossref
Farkash  E, Weintraub  AY, Sergienko  R, Wiznitzer  A, Zlotnik  A, Sheiner  E.  Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes.  Eur J Obstet Gynecol Reprod Biol. 2012;162(1):24-27. doi:10.1016/j.ejogrb.2012.01.024PubMedGoogle ScholarCrossref
Smaill  FM, Vazquez  JC.  Antibiotics for asymptomatic bacteriuria in pregnancy.  Cochrane Database Syst Rev. 2015;(8):CD000490.PubMedGoogle Scholar
U.S. Preventive Services Task Force. Procedure Manual. https://www.uspreventiveservicestaskforce.org/Page/Name/procedure-manual. Published 2018. Accessed June 28, 2019.
Nicolle  LE, Gupta  K, Bradley  SF,  et al.  Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America  [published online March 21, 2019].  Clin Infect Dis. doi:10.1093/cid/ciy1121Google Scholar
Canadian Task Force on Preventive Health Care (CTFPHC). Asymptomatic Bacteriuria in Pregnancy (2018). CTFPHC website. https://canadiantaskforce.ca/guidelines/published-guidelines/asymptomatic-bacteriuria/. Published 2018. Accessed August 19, 2019.
American Academy of Family Physicians (AAFP). Summary of Recommendations for Clinical Preventive Services. AAFP website. https://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations.pdf. Published 2017. Accessed August 19, 2019.
National Institute for Health and Care Excellence (NICE). Urinary tract infection (lower): antimicrobial prescribing. NICE website. https://www.nice.org.uk/guidance/ng109. Published 2018. Accessed August 19, 2019.
American Academy of Pediatrics and American College of Obstetricians and Gynecologists.  Guidelines for Prenatal Care. 7th ed. Itasca, IL: American Academy of Pediatrics; 2012.
American College of Obstetricians and Gynecologists (ACOG).  ACOG Practice Bulletin No. 91: treatment of urinary tract infections in nonpregnant women.  Obstet Gynecol. 2008;111:785-794. doi:10.1097/AOG.0b013e318169f6efPubMedGoogle ScholarCrossref
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