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JAMA Patient Page
September 24, 2019

Screening for Asymptomatic Bacteriuria

JAMA. 2019;322(12):1222. doi:10.1001/jama.2019.14876

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for asymptomatic bacteriuria in adults.

What Is Asymptomatic Bacteriuria?

The urinary tract includes the kidneys, ureters, bladder, and urethra. When bacteria are present in any part of the urinary tract, they can sometimes cause symptoms such as pain or burning with urination, frequent urination, pelvic or back pain, or fever—this is called a urinary tract infection. However, some people have bacteria in the urinary tract but have no signs or symptoms of infection—this is called asymptomatic bacteriuria. Asymptomatic bacteriuria is more common in women than in men because of women’s urinary tract anatomy. Most cases of asymptomatic bacteriuria are not harmful and do not need to be treated with medication (antibiotics). However, in pregnant women, there is a higher chance that asymptomatic bacteriuria will lead to more severe infection (such as in the kidneys), which can pose a danger to both the mother and fetus. Therefore, asymptomatic bacteriuria in pregnant women should be treated with antibiotics.

What Tests Are Used to Screen for Asymptomatic Bacteriuria?

In the standard screening test, a urine sample is collected in a cup for a urine culture, which allows bacteria to grow and be identified.

What Is the Patient Population Under Consideration for Screening for Asymptomatic Bacteriuria?

This USPSTF recommendation applies to adults who have no signs or symptoms of a urinary tract infection, as well as pregnant women of any age.

What Are the Potential Benefits and Harms of Screening for Asymptomatic Bacteriuria?

For pregnant women, there is adequate evidence that treating asymptomatic bacteriuria detected via screening results in fewer cases of kidney infection. Kidney infections during pregnancy are uncommon but can be serious for both mother and fetus. For nonpregnant individuals, there is adequate evidence that treating asymptomatic bacteriuria detected via screening has no benefit. Potential harms of screening include adverse effects of unnecessary antibiotics, including specific medication side effects as well as general changes to the balance of bacteria in the gut.

How Strong Is the Recommendation to Screen for Asymptomatic Bacteriuria?

Based on current evidence, the USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in pregnant women has moderate net benefit. For nonpregnant adults, the USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria has no net benefit.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: US Preventive Services Task Force recommendation statement [published September 24, 2019]. JAMA. doi:10.1001/jama.2019.13069

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