U PREVENTIVE SERVICES TASK FORCE ...

U PREVENTIVE SERVICES TASK FORCE

The U Preventive Services Task Force (USPSTF) last addressed screening for asymptomatic bacteriuria in the 1996 Guide to Clinical Preventive Services, 2d ed and made the following recommendations: all pregnant women should be veiled for asymptomatic bacteriuria using urine civilization at 12 to 16 weeks' gestation (A recommendation); and routine screening of pregnant women using leukocyte esterase or nitrite testing was not commended because of poor test characteristics compared with urine cultivation (D recommendation). (1) There was insufficient evidence to commend for or against routine screening of ambulatory somewhat old women or women with diabetes using leukocyte esterase or nitrite testing (C recommendation). (1) Routine screening for asymptomatic bacteriuria using leukocyte esterase or nitrite testing was not make acceptableed for other asymptomatic persons, including institutionalized somewhat old persons (E recommendation), school-aged girls (E recommendation), and other children, adolescents, and adults (D recommendation). (1) Screening for asymptomatic bacteriuria with microscopy testing was not approveed (D recommendation). (1)

Since the time these recommendations were released, the USPSTF criteria to rate the nerve of the evidence have changed. Therefore, the recommendation statement that tread in the steps ofs has been updated and revised based forward the current USPSTF methodology and rating of the might of the evidence. (2) Explanations of the instant USPSTF ratings and of the puissance of overall evidence are given in Tables 1 and 2 respectively. This recommendation statement and the brief update "Screening for Asymptomatic Bacteriuria," (3) are available by the agency of the USPSTF Web site (http://www.preventiveservices.ahrq.gov), end the National Guideline Clearinghouse (http://www.guideline.gov), and in print by the and of the AHRQ Publications Clearinghouse (telephone: 1-800-358-9295; e-mail: ahrqpubs@ahrq.gov).

Summary of Recommendations

The USPSTF vehemently recommends screening for asymptomatic bacteriuria with urine tillage in pregnant women at 12 to 16 weeks' gestation. A recommendation.

The USPSTF base good evidence that screening pregnant women for asymptomatic bacteriuria with urine refinement significantly reduces symptomatic urinary tract infections, depressed birth weight, and preterm delivery. The benefits of screening and treatment substantially outweigh any potential harms.

The USPSTF commends against routine screening for asymptomatic bacteriuria in men and nonpregnant women D recommendation.

The USPSTF institute fair evidence that screening men and nonpregnant women for asymptomatic bacteriuria is ineffective in improving clinical results In the absence of evidence of benefit, the potential harms associated with overuse of antibiotics are especially significant.

Clinical Considerations

* The screening experiments used commonly in the primary care setting (i.e., dipstick urinanalysis and direct microscopy) have poor positive and negative predictive values for detecting bacteriuria in asymptomatic human frames Urine culture is the gold standard for detecting asymptomatic bacteriuria however is expensive for routine screening in populations with a reasonable prevalence of this condition. conclusions from one study done with a recently made known enzymatic urine-screening test (Uriscreen) showed that the proof has a sensitivity of 100 percent and a specificity of 81 percent

* righteous evidence exists that screening pregnant women for asymptomatic bacteriuria with urine refinement (rather than urinalysis) significantly shortens symptomatic urinary tract infections, soft birth weight, and preterm delivery. A specimen obtained at 12 to 16 weeks' gestation will discover approximately 80 percent of patients with asymptomatic bacteriuria. The optimal frequent occurrence of subsequent urine testing during pregnancy is uncertain.

* worthy evidence exists that screening bodily forms other than pregnant women for asymptomatic bacteriuria does not significantly improve clinical consequences Results from a study of women with diabetes who were treated for asymptomatic bacteriuria demonstrated no reduction in complications. (4) Although there were short-term be the effects in clearing bacteriuria with antimicrobial therapy, there was no decrease in the number of symptomatic episodes or hospitalizations through the long term. Furthermore, the high rate of resort of bacteriuria in those who were protectioned and treated resulted in a marked increase in the use of antimicrobial agents.

This clinical make easy conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical make contented presented with practice recommendations supported through evidence that has been systematically reviewed from an AAFP-approved source. The practice recommendations in this activity are available online at http://www.ahrq.gov/clinic/3rduspstf/asymbac/asymbacup.htm.

This is united in a series excerpted from the Recommendation Statements released through the U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening proofs counseling, and chemoprevention. The concluded statement is available in HTML and PDF formats end the AFP Web site at http://www.aafp.org/afp/20050415/us.html. This statement is part of AFP's CME diocese "Clinical Quiz" on page 1473