Table 3:

National and international recommendations on screening for asymptomatic bacteriuria in pregnancy

Guideline groupRecommendation
Canadian Task Force on Preventive Health Care (current guideline, 2018)We recommend screening pregnant women once during the first trimester with urine culture for asymptomatic bacteriuria (weak recommendation; very low-quality evidence).
This recommendation applies to pregnant women who are not experiencing symptoms of a urinary tract infection and are not at increased risk for asymptomatic bacteriuria.
Canadian Task Force on the Periodic Health Examination11Good evidence to include screening once by culture method for asymptomatic bacteriuria at 12–16 weeks of pregnancy.
United States Preventive Services Task Force34The 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 their first prenatal visit, if later. (Grade A: The United States Preventive Services Task Force recommends the service. There is high certainty that the net benefit is substantial.)
Scottish Intercollegiate Guidelines Network, Scotland35Standard quantitative urine culture should be performed routinely at first antenatal visit (Grade A).
Confirm the presence of bacteriuria in the urine with a second urine culture (Grade A).
Do not use dipstick testing to screen for bacterial urinary tract infection at the first or subsequent visits (Grade A).
Treat asymptomatic bacteriuria detected during pregnancy with an antibiotic (Grade A).
Women with bacteriuria that is confirmed by a second urine culture should be treated and have repeat urine culture at each antenatal visit until delivery (Grade C).
The National Institute for Health and Care Excellence, UK36Women should be offered routine screening for asymptomatic bacteriuria by midstream urine culture early in pregnancy. Identification and treatment of asymptomatic bacteriuria reduce the risk of pyelonephritis.
The American Academy of Family Physicians37Pregnant women should be screened for asymptomatic bacteriuria in the first trimester of pregnancy (Grade A: consistent, good-quality patient-oriented evidence).
Pregnant women who have asymptomatic bacteriuria should be treated with antimicrobial therapy for 3 to 7 days (Grade B: inconsistent or limited-quality patient-oriented evidence).
The Infectious Disease Society of America38The diagnosis of asymptomatic bacteriuria should be based on results of culture of a urine specimen collected in a manner that minimizes contamination (Grade A-II).
Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive (Grade A-I).
Periodic screening for recurrent bacteriuria should be undertaken after therapy (Grade A-III).
No recommendation can be made for or against repeated screening of women who are culture negative in later pregnancy.