Asymptomatic bacteriuria in pregnancy: Screening urinalysis or urine culture

1997 ◽  
Vol 176 (1) ◽  
pp. S188
Author(s):  
R. Figueroa ◽  
E. Leikin ◽  
A. Bertkau ◽  
N. Tejani
Keyword(s):  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
In Pregnancy

scholarly journals Asymptomatic bacteriuria in pregnancy: what is the validity of urine sediment microscopy as a screening tool in a low resource setting?

2020 ◽  
Vol 9 (6) ◽  
pp. 2442
Author(s):  
Rashmi Polnaya ◽  
Amritha Bhandary
Keyword(s):  
Predictive Value ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urine Sediment ◽  
Predictive Values ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Urine Microscopy ◽  
In Pregnancy

Background: Asymptomatic bacteriuria in pregnancy should be screened and treated to reduce the risk of morbidity and mortality. Urine culture is the recommended test. In low resource setting with large patient load urine culture in all pregnant patients is not feasible. In this study authors have assessed the validity of urine microscopy in the screening of asymptomatic bacteriuria in pregnancy.Methods: Midstream clean catch urine specimen collected from 675 pregnant women was subjected to urine sediment microscopy and culture. It was considered screen positive if pus cells were >5/HPF. Asymptomatic bacteriuria was diagnosed if there were >/=100000 CFU of a single uropathogen per ml. Results obtained were statistically analysed for the prevalence of asymptomatic bacteriuria, sociodemographic and medical risk factors, causative organisms, antibiotic sensitivity and validity of urine sediment microscopy in detecting asymptomatic bacteriuria.Results: The incidence of asymptomatic bacteriuria in our study was 10.2%. The incidence was higher in the age group between 20-30 years, in gravida 3 and above, in upper lower and lower socioeconomic status, in women with hyperglycemia in pregnancy and anaemia. E. coli was the commonest bacterial isolate in culture positive cases. Bacterial isolates had poor sensitivity for Ampicillin, amoxicillin and nitrofurantoin and good sensitivity for cephalosporins and aminoglycosides. The sensitivity, specificity, positive and negative predictive values for urine microscopy was 43%, 85%, 25% and 93% respectively.Conclusions: This study shows poor sensitivity and positive predictive value and good specificity and negative predictive value.

scholarly journals Assessment of Rapid Dipstick Test for Diagnosis of Urinary Tract Infection in Asymptomatic Pregnant Female

2016 ◽  
Vol 5 (1) ◽  
pp. 965
Author(s):  
Ashish Khanna ◽  
Menka Khanna
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Gold Standard ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Culture Method ◽  
Premature Delivery ◽  
Dipstick Test ◽  
In Pregnancy

<strong>Background:</strong>Bacteriuria during pregnancy has been known to cause many complications like low birth weight and premature delivery.<p><strong>Objective</strong>: This study was done to evaluate the diagnostic accuracy of rapid dipstick test to predict urinary tract infection in pregnancy against the gold standard urine culture.</p><p><strong>Material&amp;Methods:</strong> A total of 200 mid stream urine samples were collected from asymptomatic pregnant females. These specimens were cultured in blood agar and MacConkey's agar by using the standard loop technique and incubated aerobically at 37°C overnight. The criterion for clinically significant bacteriuria was either a pure or predominant culture of &gt;10<sup>5</sup> colony forming units (CFU)/ml. All the specimens were also examined microscopically for pyuria and bacteriuria.</p><p><strong>Results:</strong> The prevalence of asymptomatic bacteriuria in pregnancy was 15 % in our study. The sensitivity and the specificity for leucocyte esterase were 85.7% and 74.4% and for nitrites, they were 64.2% and 72%.</p><p><strong>Conclusion:</strong> The study revealed that use of either leukocyte esterase or nitrite for screening of asymptomatic bacteriuria in pregnancy was associated with many false positive and negative results when compared with the gold standard urine culture method. By using their combination maximum negative predictive value of .98 was achieved.</p>

scholarly journals A study of prevalence of asymptomatic bacteriuria in pregnant women from rural areas attending to Obstetric Department in Akash Hospital, Karnataka, India

2019 ◽  
Vol 8 (7) ◽  
pp. 2845
Author(s):  
Rohini N. S. ◽  
Ravishankar S. N. ◽  
Kala K. ◽  
Rakshith N. R.
Keyword(s):  
Pregnant Women ◽  
Urine Culture ◽  
Screening Method ◽  
Asymptomatic Bacteriuria ◽  
Significant Risk ◽  
Screening Tests ◽  
Rapid Screening ◽  
Screening Methods ◽  
Gram Staining ◽  
In Pregnancy

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant risk factor for developing upper urinary tract infection and pyelonephritis which is associated with significant maternal and fetal risks. The aim of this study was to know the prevalence of asymptomatic bacteriuria in pregnancy, to identify the organisms and their antibiotic susceptibility patterns and to formulate a single or combined rapid screening method as an acceptable alternative to urine culture.Methods: A total of 375 pregnant women aged between 18 to 45 years were included in this study. Clean catch mid-stream urine samples were collected. Screening tests done were gram staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase test. Identification of pathogens and antibiotic sensitivity tests were performed as per standard urine culture and sensitivity methods.Results: Out of the 375 pregnant women, 31 (8.4%) had significant bacteriuria. High percentage of women with ASB were primigravidas (51.38%) and in 2nd trimester (43.86%). The most common organism isolated was E.coli (56.14%). In screening tests, gram staining of uncentrifuged urine had a sensitivity of 85.71%. Sensitivity of 71.42% was found in Nitrite and leucocyte esterase tests. However, the combination of these two tests, with either test positive, showed sensitivity and negative predictive value of 90.47% and 99.09% respectively.Conclusions: Early detection and treatment of ASB in pregnancy can prevent complications. ASB can be identified by simple and combined rapid screening methods and urine culture along with antibiogram. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.

scholarly journals Asymptomatic Bacteriuria in Pregnant Women

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Achala Thakur ◽  
Ratna Baral ◽  
Pritha Basnet ◽  
Rubina Rai ◽  
Ajay Agrawal ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Signs And Symptoms ◽  
Acinetobacter Species ◽  
Significant Difference ◽  
Culture Sensitivity ◽  
Pregnancy Urine ◽  
A Prospective Study ◽  
In Pregnancy

Introduction: Asymptomatic bacteriuria is the significant presence of bacteria in urine of an individual without symptoms. The aim of the study is to determine the prevalence of asymptomaticbacteriuria in pregnant women. Methods: This study was a prospective study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences. The duration of the study was six monthsfrom January to June 2012. A total of 600 pregnant women were enrolled. All women were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collectedfrom each patient into a sterile vial. The urine samples were examined for microscopic and culture sensitivity test. Results: Out of 600 pregnant women, 52 were positive for significant bacteriuria with a prevalence rate of 8.7%. There was a significant difference in prevalence of asymptomatic bacteriuria withrespect to trimester (p=0.005). Age did not show any significant difference in the prevalence of asymptomatic bacteriuria (p=0.807). There was not any significant difference in the prevalence ofasymptomatic bacteriuria with respect to parity (p=0.864) and booking status (p=0.397). Escherichia coli (35%), Acinetobacter species (15%), Enterococcus species (12%) and Klebsiella pneumoniae (10%)were the common isolates. Most of the isolates were sensitive either to Nitrofurantoin, Norfloxacin or Amikacin. Conclusions: Asymptomatic bacteriuria is common in pregnancy. Urine culture sensitivity should be carried out routinely on all pregnant patients in order to prevent the dangerous complicationsassociated with it. Keywords: asymptomatic bacteriuria in pregnancy; urine culture and sensitivity.

scholarly journals Asymptomatic Bacteriuria in Pregnancy Complicated by Pyelonephritis Requiring Nephrectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Sharon J. Kim ◽  
Pavan Parikh ◽  
Amanda N. King ◽  
Mary L. Marnach
Keyword(s):  
Risk Factors ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
The United States ◽  
Multidrug Resistant ◽  
Perinephric Abscess ◽  
High Risk Factors ◽  
Colony Forming Units ◽  
Prenatal Screen ◽  
In Pregnancy

Routine prenatal care in the United States includes screening for asymptomatic bacteriuria (ASB), which occurs in 2 to 7 percent of pregnant women and can cause urinary tract infection and pyelonephritis. We present the case of a pregnant woman affected by multidrug resistant Klebsiella induced ASB during her prenatal screen, which was untreated due to a repeat urine culture showing mixed flora; subsequently, the patient’s postpartum course was complicated by pyelonephritis and perinephric abscess, concluding in a radical nephrectomy. Current recommendations are to treat ASB after two consecutive voided urine cultures showing the same bacterial strain in quantitative counts of =/> 10(5) colony forming units (cfu)/mL or a single-catheterized specimen with quantitative count of =/> 10(2) cfu/mL. For women with ASB in their prenatal screen or other high risk factors, consideration should be given to testing urine cultures every trimester until the completion of pregnancy to prevent the complications of persistent bacteriuria.

scholarly journals Effect of asymptomatic bacteriuria on pregnancy outcome: a review

2021 ◽  
Vol 10 (4) ◽  
pp. 1753
Author(s):  
Nalam Neelima ◽  
Ushadevi Gopalan
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Early Detection ◽  
Gestational Age ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Upper Urinary Tract ◽  
Culture And Sensitivity ◽  
In Pregnancy

Asymptomatic bacteriuria is more common in pregnancy and if left untreated it may progress to upper urinary tract infection. Early detection and treatment of asymptomatic bacteriuria prevents further progression of the infection and thereby preventing undesirable complications to the mother and fetus. It is advisable to do Urine culture and sensitivity in all antenatal women irrespective of the gestational age and symptoms.

scholarly journals Role of routine urine culture in predicting asymptomatic bacteriuria in pregnancy and the prevalence of asymptomatic bacteriuria in pregnant women - Our experience

2021 ◽  
Vol 8 (4) ◽  
pp. 513-517
Author(s):  
Aparna Krishnamurthy ◽  
Shazia Khan ◽  
Tina Singh
Keyword(s):  
Pregnant Women ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Renal Calculi ◽  
Culture Sensitivity ◽  
History Of ◽  
Sensitivity Standard ◽  
Or History ◽  
In Pregnancy

Asymptomatic bacteriuria (ASB) in pregnancy can flare into frank pyelonephritis and sepsis if untreated due to the low immunity. Apart from causing morbidity in mothers it affects the foetus by increasing the incidence of prematurity and IUGR. The present study was undertaken to determine the prevalence of ASB in the pregnant women attending Ante natal clinic and the significance of routine urine culture. : Total 310 pregnant women attending the antenatal OPD were enrolled in the study over a period of 10 months. Inclusion criteria included all pregnant women attending antenatal OPD without any urinary symptoms or history of fever. Exclusion criteria included frank UTI symptoms like fever, dysuria, increased frequency of urine, any history of intake of antibiotics, any urinary tract anomaly or renal calculi. Their midstream urine sampling was collected and subjected to both microscopy and culture sensitivity; standard microbiological method was used. The prevalence of ASB was found to be 11.29% and was maximum in second trimester (54.2%). The study revealed routine urine culture is a sensitive test to diagnose ASB. The commonest bacterium isolated was Escherichia coli (51.4% cases) and the most effective antibiotic was Nitrofurantoin. The neonatal outcomes are discussed in the text while no perinatal deaths were recorded during the period of study. No direct association of asymptomatic bacteriuria with anaemia and preeclampsia was found, but odds ratio was more than one. The study highlights that asymptomatic bacteriuria is a common occurrence in pregnant women, including urine culture as a part of routine investigation in antenatal patients can help diagnose this condition. Prompt treatment of ASB can prevent any obstetric complication arising from the flareup of asymptomatic bacteriuria in pregnancy and thus reduce maternal and foetal morbidity.

scholarly journals 10-Year Trends in Urine Testing and Treatment in Patients with Spinal Cord Injury: An Opportunity for Targeted Stewardship

2020 ◽  
Vol 41 (S1) ◽  
pp. s90-s90
Author(s):  
Alison Nelson ◽  
Kalpana Gupta ◽  
Judith Strymish ◽  
Maura Nee ◽  
Katherine Linsenmeyer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Antibiotic Treatment ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Routine Screening ◽  
Organizational Level ◽  
Cord Injury ◽  
Urine Testing ◽  
Over Time

Background: Guidelines regarding asymptomatic bacteriuria (ASB) have consistently recommended against screening and treatment in most circumstances. However, screening of patients with spinal cord injury (SCI) is common practice and in some cases is a formal protocol at the organizational level. A previous study found that more than one-third of patients with ASB detected on routine screening cultures performed at annual visits in 2012 received antibiotics. However, the role of antibiotic stewardship has become more prominent over the last decade. We hypothesized that diagnostic and therapeutic stewardship efforts may be impacting the practice of annual urine-culture screening for SCI patients. We evaluated urine culture screening and treatment rates over a 10-year period. Methods: Patients with SCI seen in the VA Boston HCS for an annual exam in 2018 were eligible for inclusion and formed the baseline cohort for this study. Annual visits for the cohort over a 10-year period (January 1, 2009–December 31, 2018) were included in the analysis. Electronic data collection and manual chart review were utilized to capture outcomes of interest including urine culture, antibiotic prescriptions and indication within 15 days, and documentation of urinary or infectious symptoms. The main outcomes were (1) rate of urine cultures performed ±3 days of the visit, (2) rate of antibiotic treatment in asymptomatic patients, and (3) trend over time of urine culturing and treating. The χ2 test for trend was used to compare rates over time. Results: In total, 1,962 annual visits were made by the 344 unique patients over the 10-year period and were available for analysis. Among these, 639 (32.6%) visits had a urine culture performed within 3 days. The proportion of visits with a collected culture decreased from (109 of 127) 85.8% of visits in 2009 to (65 of 338) 19.2% of visits in 2018, P ≤ .001 (Fig. 1). In the treatment analysis, 39 visits were excluded for active symptoms, concern for uncontrolled infection, or prophylaxis as antibiotic indication. Among 600 remaining screening cultures, 328 had a bacterial pathogen or >100,000 mixed colonies consistent with ASB. Overall, 51 patients (17%) received antimicrobials. The rate of antibiotic treatment for ASB did not significantly decrease over time pP = 0.79 (Fig. 2). Conclusions: Over a 10-year period of annual SCI visits, the proportion of visits with a urine culture performed as routine screening significantly and consistently decreased. However, the rate of treatment for positive urine cultures remained consistent. These data support targeted diagnostic stewardship in this population to reduce unnecessary antibiotic use.Funding: NoneDisclosures: None

scholarly journals 238. Novel Way to Evaluate Antibiotic Use Appropriateness: Moving Towards the “Never Event” Classification by Electronic Algorithm

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S119-S120
Author(s):  
Twisha S Patel ◽  
Lindsay A Petty ◽  
Jiajun Liu ◽  
Marc H Scheetz ◽  
Nicholas Mercuro ◽  
...  
Keyword(s):  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Data Capture ◽  
Electronic Data Capture ◽  
Electronic Data ◽  
False Positivity ◽  
Never Event ◽  
Manual Review

Abstract Background Antibiotic use is commonly tracked electronically by antimicrobial stewardship programs (ASPs). Traditionally, evaluating the appropriateness of antibiotic use requires time- and labor-intensive manual review of each drug order. A drug-specific “appropriateness” algorithm applied electronically would improve the efficiency of ASPs. We thus created an antibiotic “never event” (NE) algorithm to evaluate vancomycin use, and sought to determine the performance characteristics of the electronic data capture strategy. Methods An antibiotic NE algorithm was developed to characterize vancomycin use (Figure) at a large academic institution (1/2016–8/2019). Patients were electronically classified according to the NE algorithm using data abstracted from their electronic health record. Type 1 NEs, defined as continued use of vancomycin after a vancomycin non-susceptible pathogen was identified, were the focus of this analysis. Type 1 NEs identified by automated data capture were reviewed manually for accuracy by either an infectious diseases (ID) physician or an ID pharmacist. The positive predictive value (PPV) of the electronic data capture was determined. Antibiotic Never Event (NE) Algorithm to Characterize Vancomycin Use Results A total of 38,774 unique cases of vancomycin use were available for screening. Of these, 0.6% (n=225) had a vancomycin non-susceptible pathogen identified, and 12.4% (28/225) were classified as a Type 1 NE by automated data capture. All 28 cases included vancomycin-resistant Enterococcus spp (VRE). Upon manual review, 11 cases were determined to be true positives resulting in a PPV of 39.3%. Reasons for the 17 false positives are given in Table 1. Asymptomatic bacteriuria (ASB) due to VRE in scenarios where vancomycin was being appropriately used to treat a concomitant vancomycin-susceptible infection was the most common reason for false positivity, accounting for 64.7% of false positive cases. After removing urine culture source (n=15) from the algorithm, PPV improved to 53.8%. Conclusion An automated vancomycin NE algorithm identified 28 Type 1 NEs with a PPV of 39%. ASB was the most common cause of false positivity and removing urine culture as a source from the algorithm improved PPV. Future directions include evaluating Type 2 NEs (Figure) and prospective, real-time application of the algorithm. Disclosures Marc H. Scheetz, PharmD, MSc, Merck and Co. (Grant/Research Support)

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