USA TASK FORCE "USPSTF" SUGGEST SCREENING OF ALL PREGNANTS FOR 'ASYPTOMATIC BACTERIURIA'

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The USPSTF or " the United States Preventive Services Task Force "recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later. 

In pregnant women, asymptomatic bacteriuria has been associated with an increased incidence of pyelonephritis and low birthweight (birthweight <2500 g).Asymptomatic bacteriuria can be reliably detected through urine culture. The presence of at least 105 colony-forming units per mL of urine, of a single uropathogen, and in a midstream clean-catch specimen is considered a positive test result.

In pregnant women, convincing evidence indicates that detection of and treatment for asymptomatic bacteriuria with antibiotics significantly reduces the incidence of symptomatic maternal urinary tract infections and low birthweight. In men and nonpregnant women, adequate evidence suggests that screening men and nonpregnant women for asymptomatic bacteriuria is ineffective in improving clinical outcomes.

The screening tests used commonly in the primary care setting (dipstick analysis and direct microscopy) have poor positive and negative predictive value for detecting bacteriuria in asymptomatic persons. Urine culture is the gold standard for detecting asymptomatic bacteriuria but is expensive for routine screening in populations with a low prevalence of the condition. However, no currently available tests have a high enough sensitivity and negative predictive value in pregnant women to replace the urine culture as the preferred screening test. Pregnant women with asymptomatic bacteriuria should receive antibiotic therapy directed at the cultured organism and follow-up monitoring.

Recommendations of Others The American Academy of Family Physicians strongly recommends that all pregnant women be screened for asymptomatic bacteriuria using urine culture at 12 to 16 weeks' gestation or at the first prenatal visit if after that time. The Infectious Diseases Society of America recommends screening pregnant women for asymptomatic bacteriuria with a urine culture "at least once" in early pregnancy. It also states that screening for asymptomatic bacteriuria in nonpregnant women, diabetic women, or community-dwelling or institutionalized older persons is not indicated. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend screening for asymptomatic bacteriuria "early in pregnancy, as appropriate". The American College of Obstetricians and Gynecologists recommends screening for asymptomatic bacteriuria in nonpregnant women with diabetes mellitus. Tools