The US Preventive Services Task Force (USPSTF) has updated its screening recommendations for asymptomatic bacteriuria by urine culture in pregnant persons (B recommendation), according to a statement published in the Journal of the American Medical Association.1
During pregnancy, asymptomatic bacteriuria may develop in a small percentage of women, which may increase the risk for pyelonephritis. To update the 2008 recommendation statement, the USPSTF commissioned a systematic evidence review to evaluate the potential benefits and harms of screening for and treating asymptomatic bacteriuria.
The USPSTF concluded with moderate certainty that screening for and treating asymptomatic bacteriuria in pregnant persons has a moderate net benefit in reducing perinatal complications. The USPSTF found inadequate evidence on the harms of screening for asymptomatic bacteriuria in pregnant persons, although these harms are thought to be small.
With moderate certainty, the USPSTF concludes that screening for and treating asymptomatic bacteriuria in nonpregnant adults has no net benefit. The harms associated with treatment of nonpregnant individuals include adverse effects associated with antibiotic use and changes to the microbiome. Therefore, USPSTF determined the overall degree of harm to be at least small in this group.
The major update to the 2008 recommendation is that the USPSTF changed the grade for pregnant persons from “A” to “B.”
In an accompanying editorial, Lindsay E. Nicolle, MD, FRCPC, stated, “The updated USPSTF guidelines contribute to the evolution of management of asymptomatic bacteriuria in healthy women. However, 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.”2
1. US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, et al. Screening for asymptomatic bacteriuria in adults: US Preventive Services Task Force recommendation statement. JAMA. 2019;322(12):1188-1194.
2. Nicolle LE. Updated guidelines for screening for asymptomatic bacteriuria. JAMA. 2019;322(12):1152-1154.