Should primary care clinicians screen pregnant persons for asymptomatic bacteriuria?

In this updated 2019 review, The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians screen pregnant persons for asymptomatic bacteriuria using a midstream, clean-catch urine culture at the first prenatal visit or at 12 to 16 weeks gestation, whichever is earlier. (B recommendation) The Task Force recommends against screening for asymptomatic bacteriuria in nonpregnant adults. (D recommendation) These recommendations are a change in grade for pregnant persons from an "A" to a "B" recommendation compared to the previous 2008 USPSTF recommendation statement. (Other patient-oriented evidence) (LOE = 2c)

US Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults. US Preventive Services Task Force recommendation statement. JAMA 2019;322(12):1188-1194.  [PMID:31550038]

Practice guideline

Government

Population-based

In this updated review, the Task Force found adequate evidence that treatment of screen-detected asymptomatic bacteriuria can reduce the incidence of pyelonephritis in pregnant persons and associated complications including low infant birth weight. The Task Force also found that evidence of harm associated with treatment including adverse effects of antibiotic treatment is at least small in magnitude. However, given newer evidence that the risk of pyelonephritis is significantly lower that found in previous reviews, the Task Force changed the grade for pregnant persons from an "A" to a "B" recommendation (moderate certainty of moderate net benefit). There is no evidence that treatment of screen-detected asymptomatic bacteriuria in otherwise low risk nonpregnant adults has any benefit. The current recommendations are consistent with guidelines released by the American College of Obstetricians and Gynecologists, the Canadian Task Force, and the American Academy of Family Physicians.