Screening For Asymptomatic Bacteriuria Research Articles

Asymptomatic bacteriuria screening for developing countries using a modified water quality test kit.

Between 2% and 15% of pregnant women unknowingly experience asymptomatic bacteriuria (ASB), defined as ≥105 CFU per milliliter of urine in the absence of symptoms. ASB increases the risk of adverse pregnancy outcomes including pyelonephritis, preterm labor, and low-birth weight infants. While pregnant women in the United States are routinely screened for ASB, those in developing countries with limited resources and funding lack an accurate mechanism for ASB screening. Aquagenx water quality test kits detect Escherichia coli, the most common causative agent of ASB, and total coliform bacteria in drinking water via colorimetric and fluorescent indicators. We found that the Aquagenx system is compatible with human urine and then proceeded to develop an ASB screening protocol using disposable inoculating loops. Our protocol diagnosed artificial ASB- samples (104 CFU/mL E. coli) with a false positive (FP) rate of 33% (n = 18) and ASB+ (105 CFU/mL E. coli) with a false negative (FN) rate of 5.6% (n = 18). Clinical sample testing with our protocol revealed a FP rate of 0% in ASB- samples (n = 28) and a FN rate of 0% in ASB+ samples caused by coliforms (n = 13). Aquagenx did not detect ASB in nine clinical samples with non-coliform etiological agents due to the limitations of the technology. However, with very high accuracy for detection of E. coli and other causative agents that collectively account for 90.1% of ASB cases, these kits could be used as a diagnostic ASB screening tool in developing countries in which there is currently no alternative to urine culture.IMPORTANCEAsymptomatic bacteriuria (ASB) affects 2%-15% of pregnant women and can result in adverse maternal and fetal outcomes if left undetected and untreated. In the United States and other developed nations, pregnant women are regularly screened for ASB via urine culture. However, in low-resource countries where bacterial culture is not available, dipstick testing is used. Although accurate in cases of symptomatic bacteriuria, dipstick detection is ineffective for detecting ASB. Here, we made use of an existing water quality field test for ASB urine screening, which would be readily deployable in low-resource settings. We optimized a dilution protocol for sampling patient urine within the detection limits of the Aquagenx kit technology. Overall, we were able to detect ASB samples with Gram-negative pathogens that collectively account for 90% of all ASB cases. Utilization of this repurposed technology for proactive medical screening may help prevent adverse pregnancy and birth outcomes due to ASB.

Asymptomatic Bacteriuria: Multidisciplinary Perspectives

Asymptomatic bacteriuria (ASB) is the presence of a sufficient quantity of at least one bacterial species in the urine of a patient without any related symptoms. ASB may be diagnosed by urinalysis in a variety of settings. However, routine screening and treatment is not evidence-based in most clinical situations, and antibiotic use in this setting contributes to unintended outcomes including antimicrobial resistance. Personal and institutional practice should use a multidisciplinary approach to apply the best available evidence to minimize screening for ASB and avoid associated antimicrobial treatment.

Acute febrile illness in pregnancy: Spectrum of disease and impact on maternal and foetal outcome.

Acute febrile illness (AFI) in pregnancy is a neglected cause of maternal and foetal mortality and morbidity in low-and middle-income countries. This prospective cohort studied antenatal and postpartum women admitted with acute fever to a tertiary care university teaching hospital from July 2014 to March 2015 for aetiology, maternal and foetal complications, and the impact on maternal mortality ratio (MMR) and perinatal mortality rate. Among the 180 women admitted with AFI, urinary tract infection 54(30%) was the commonest cause, followed by airborne infections (67; 37.2%), peripartum or wound infections (25; 13.8%) and vector-borne diseases (21; 11.6%). Maternal deaths were 4 (2%) and foetal deaths 9 (5%). Post-operative gram-negative sepsis was the most common cause of maternal mortality. The MMR was ten times higher with AFI 2778 against 197 (p < 0.0001) among the other hospital deliveries during the same period. Screening for asymptomatic bacteriuria , maintaining aseptic precautions, and vaccination may impact maternal and foetal morbidity significantly.

Risk Factors and Clinical Outcomes of Asymptomatic Bacteriuria in Pregnant Women: A Comprehensive Analysis.

Background Asymptomatic bacteriuria (ASB) in pregnant women poses risks to maternal and neonatal health. Understanding its prevalence and associated risk factors is crucial for effective management. This study aimed to determine the prevalence of ASB among pregnant women and identify associated risk factors. Methodology A cross-sectional study involving 294 pregnant women was conducted. ASB prevalence was determined, and bivariate analysis was performed to identify associated risk factors. Logistic regression analysis was employed to assess the significance of identified risk factors. Results The overall prevalence of ASB was 17.34%. Bivariate analysis revealedassociations between ASB and maternal age (p > 0.05), socioeconomic status (p < 0.001), previous urinary tract infection (UTI) history (p < 0.001), diabetes mellitus (p = 0.00204), and anemia (p = 0.522). Multivariate logistic regression confirmed significant associations of ASB with maternal age (p = 0.008), parity (p = 0.001), previous UTI (p < 0.001), and diabetes mellitus (p < 0.001). Conclusion This study underscores the importance of screening for ASB during prenatal care, particularly among pregnant women with advanced maternal age, higher parity, previous urinary tract infection (UTI) history, and diabetes mellitus. Tailored screening strategies and prompt treatment can mitigate the risks associated with untreated ASB, improving maternal and neonatal outcomes. Healthcare providers should integrate these findings into routine antenatal care protocols to optimize maternal and fetal health.

Pregnancy-associated asymptomatic bacteriuria and antibiotic resistance in the Maternity and Children's Hospital, Arar, Saudi Arabia.

The Ministry of Health in Saudi Arabia provides comprehensive antenatal care for all pregnant women with all required investigations. However, it does not include urine culture for diagnosis of asymptomatic bacteriuria (ASB). This is the first study to evaluate the prevalence of ASB among pregnant females, identify the causative organisms and determine their antibiotic susceptibility patterns in the Maternity and Children's Hospital, Arar, Saudi Arabia. This cross-sectional study included 400 pregnant women attending an antenatal clinic. Two midstream urine samples were aseptically collected and screened using standard microbiological techniques including microscopic examination, dipstick testing, and urine culture. In order to interpret the urine culture results, ≥ 105 CFUs/mL was considered significant bacteriuria. Identification of the isolates and their antibiotic sensitivity testing was performed using the Vitek 2 system (BioMérieux, Marcy l'Etoile, France) with the available test kits. The prevalence of ASB was 8.25% (35/400). Significant positive correlations (p ˂ 0.05) were detected between positive urine culture results and random blood sugar, leucocytes, nitrites, pus cells, urine red blood cells, epithelial cells, and mucus. Escherichia coli was the most common causative organism (45.7%), followed by Staphylococcus aureus (22.9%). Klebsiella pneumoniae represented 11.4% of the isolates. Most of the isolated Gram-positive organisms were sensitive to many of the tested antibiotics; most of the detected Gram-negative isolates were resistant. ASB caused by antibiotic resistant organisms is alarming. Screening for ASB during pregnancy using urine culture and sensitivity testing is of vital importance to improve the maternal and neonatal outcome.

Variation of Practice in Prophylactic Protocol to Reduce Prosthetic Joint Infection in Primary Hip and Knee Arthroplasty: A National Survey in the United Kingdom.

Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterise patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

Asymptomatic bacteriuria in pregnancy

Asymptomatic bacteriuria (ASB) is diagnosed by the presence of a 10*5 colony-forming units (CFU) in the urine without any urinary symptoms. It commonly occurs in pregnancy with the incidence ranging from 2-10%. It poses a risk of progressing into pyelonephritis in pregnancy. Adverse fetal outcomes include preterm labor, neonatal sepsis, intrauterine growth restriction (IUGR) and neonatal death. Anatomical and physiological changes during pregnancy make pregnant women more vulnerable to ASB and subsequently symptomatic UTI. E coli is the commonest organism involved in ASB, followed by Klebsilla and Enterobactericiae. Evidence suggests that importance of routine screening for ASB in early pregnancy to avoid adverse fetomaternal outcomes. Reduced adverse outcomes were noted with prompt antibiotic treatment for ASB compared to untreated pregnant women with ASB. Urine culture remains as the gold standard method to diagnose ASB in pregnancy. Using urine culture as a routine screening method in Sri Lanka is limited due to financial restrictions.

Screening of asymptomatic bacteriuria in children with sickle cell disease

Abstract Background Asymptomatic bacteriuria (ASB) refers to two consecutive urine cultures growing more than 100 000 CFU/ml in a patient with no symptoms of urinary tract infection. In patients with sickle cell disease (SCD), the anatomical and physiological defects make ASB more prone to worsen the sickle nephropathy. Early detection and management of ASB in children with SCD may retard this progression. Aim To investigate the prevalence of ASB, its major determinants, and its effect on kidney functions in patients with SCD for early detection and treatment. Patients and methods The study was conducted at a children’s hospital during the period between June 2019 and February 2020. The study included 30 children previously diagnosed as having SCD. Midstream urine samples were collected twice from all patients and subjected to urinalysis and culture on chromogenic media. Only significant isolates were identified and subjected to antimicrobial susceptibility testing. Patients were divided into either ASB or sterile urine group. All patients with SCD were subjected to complete blood picture, reticulocytic count, markers of hemolysis, and serum creatinine. Results The prevalence of confirmed ASB was 16.7%. All children in ASB group had pyuria (100%). Staphylococcus saprophyticus (60%) was the commonest organism isolated, followed by Escherichia coli (20%) and Klebsiella pneumoniae (20%). Sulfamethoxazole+trimethoprim was the most sensitive antibiotic among all isolated microorganisms. The differences in kidney function results between the two groups were statistically insignificant. Conclusion ASB was of high prevalence in pediatric patients with SCD in Egypt at our hospital. Pyuria was the only major determinant. S. saprophyticus was the predominant organism. Serum creatinine was a nonsensitive marker to monitor kidney functions.

If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria

Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study. Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs). Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention. Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record.

159. Antibiotic and diagnostic stewardship surrounding pre-operative testing in patients undergoing cardiac surgery

Abstract Background Despite national guidelines from the US Preventative Services Task Force and the Infectious Diseases Society of America that recommend against screening for asymptomatic bacteriuria (ASB, defined as &amp;gt; 105 CFU of an organism) in most circumstances, pre-operative screening urine culture (UCx) continues. Detection and treatment of ASB leads to antibiotic exposure and risk of antibiotic-associated adverse events like drug reactions, Clostridioides difficile infection (CDI), and colonization by drug-resistant organisms. We describe the implementation of eliminating pre-operative screening for ASB in patients undergoing cardiac surgery. Figure 1Pre-operative checklist for cardiac surgery prior to intervention Methods This was a pre-post study of practice change involving removing ASB screening as part of the pre-cardiac surgery checklist (Figure 1). The pre-intervention period was 08/18/21 – 11/17/21, the post intervention period was 12/1/21 – 3/1/22. We identified all patients who underwent a cardiac arterial bypass graft procedure with or without vein harvesting. We reviewed pre-operative UCx, test indication, antibiotic administration pre-operatively due to culture growth, and post-operative CDI and CAUTI within 30 days post procedure identified through routine infection prevention and control surveillance. Results Pre-intervention, 117/128 (91.4%) patients undergoing cardiac surgery had a UCx collected. Of the UCx, 100% were ordered as part of the pre-operative checklist and not for symptoms. Five patients pre-intervention had ASB detected. Four patients received antibiotics to treat ASB. A fifth patient received antibiotics for bacteriuria which did not meet ASB count threshold. Post-intervention, 15/123 had a UCx (12.3%). Of these, 12/15 were ordered as part of the pre-operative checklist (80%), and the remaining three had symptoms documented. Post-intervention, one patient had ASB detected and did not receive antibiotics. Pre- and post-intervention there were 2 cases of CDI (2/128, 1.6% and 2/123, 1.6%, respectively). There were no CAUTIs either pre- or post-intervention. Conclusion Standard pre-operative UCx is known to be a low-value test and is not recommended by national guidelines. In this single-center diagnostic stewardship intervention, screening was reduced by 87.2%. There was no change in infectious outcomes. Disclosures All Authors: No reported disclosures.

Occurrence of urinary tract infection and asymptomatic bacteriuria during pregnancy and its association with maternal outcome

: The pregnancy increases the possibility of the case progressing from asymptomatic bacteriuria (ABU) to urinary tract infection (UTI) with symptoms, which may further lead to pyelonephritis and obstetric outcomes. The adverse outcome may result in premature delivery, low weight at birth, and increased foetal mortality. The present study was proposed to assess the occurrence of Symptomatic UTI and asymptomatic bacteriuria, the microorganisms causing UTI in pregnancy, to assess the socio-demographic characteristics involving the risk factors of UTI and the maternal outcome. A total of 152 pregnant women with and without symptoms of urinary tract infection were included as a study subject from January 2011 to April 2011. Midstream urine samples were collected and processed following standard bacteriological tests. In the present study 85 (55.9%) cases were symptomatic UTI and 67 (44.1%) cases were having asymptomatic bacteriuria. was the predominant organism isolated in 61 (49.6%) cases followed by in 24 (19.5%) cases, in 16 (13.0%) cases, CONS 12 (9.7%) cases and in 10 (8.1%) cases. The lower socio-economic status has contributed in 65 (42.8%) cases and the education status of the most of the cases was either high school (47.4%) or primary school (38.8%). Out of 118 cases of vaginal delivery, 101 (85.6%) cases had full term normal delivery, but among 17(14.4%) preterm delivery, 12 (10.2%) were having symptomatic UTI and 05 (4.2%) cases were having asymptomatic bacteriuria.. Our study findings showed that low socioeconomic status and education background were predominant factors associated with increased symptomatic UTI and ABU. There was no significant difference in the prevalence of UTI and ABU with respect to gestational age. It was concluded in the study that the prompt treatment of ABU early in pregnancy significantly reduces the chances of adverse pregnancy outcome. Thus, screening for ABU should ideally be done in the pre-conceptional period. It was also found in our study that higher incidence of UTI was found in third trimester. Hence all pregnant women should be checked for the presence of ABU in the 1st trimester, treated aggressively with suitable antibiotics and promptly followed up.

Screening of Asymptomatic Bacteriuria in Sickle Cell Pediatric Patients

Abstract Background Asymptomatic bacteriuria (ASB) refers to two consecutive urine cultures growing more than 100,000 colony forming units (CFU)/ml of a bacterial species in a patient with no symptoms of urinary tract infection (UTI). In sickle cell disease (SCD) patients, the anatomical and physiological defects associated with the disease make ASB more prone to worsen the sickle nephropathy and cause more kidney damage. Also, the urine concentration and acidification defects associated with SCD enhance urinary bacterial formation and proliferation. In resource poor settings where renal replacement therapy is limited, early detection and management of ASB in SCD children may retard this progression. Aim of the Work The current study aims to investigate the prevalence of asymptomatic bacteriuria, its major determinants and its effect on kidney functions in SCD patients for early detection and treatment. Patients and Methods The study was conducted at Ain Shams University Children's Hospital and the Main Microbiology Laboratory at Clinical Pathology Department during the period between June 2019 and February 2020.The study included 30 children previously diagnosed as SCD by HB electrophoresis. A fresh voided mid-stream urine samples were collected once from all patients and subjected to urinalysis and culture on chromogenic media. Patients with positive culture results were asked to get another sample to confirm their culture results, while those with contaminated results were re-Instructed with precautions to get another fresh voided mid-stream urine samples. Only significant isolates were identified and subjected to antimicrobial susceptibility testing using disk diffusion method according to CLSI 2017. Patients were divided either into ASB or sterile urine groups according to their culture results. All SCD Patients were subjected to complete blood picture (CBC), reticulocytic count, markers of haemolysis (total, indirect bilirubin and LDH) and serum creatinine. Results The prevalence of confirmed ASB was 16.7% (5/30).All children in ASB group had pyuria(100%). Staph.saprophyticus (60%) (3/5)was the commonest organism isolated from the urine of these patients, followed by E.coli (20%)(1/5) &amp; Klebsiella pnuemoniae (20%)(1/5).Sulfamethoxazole +Trimethoprim (Sutrim) was the most sensitive antibiotic among all isolated microorganisms.The difference in kidney funtion results among the two groups were statistically insignificant. Conclusion Asymptomatic bacteriuria was of high prevalence in SCD pediatric patients in Egypt at Ain Shams University Hospitals. Pyuria was the only major determinant of ASB in this study.Staph.saprophyticus was the predominant organism isolated from ASB group. Sulfamethoxazole +Trimethoprim (Sutrim) was the drug of choice for empirical treatment of UTI. Serum creatinine was a non-sensitive marker to monitor any minor impairment in kidney functions.

Low-Value Preprocedure Urinalysis Is Common in the U.S.

The U.S. Preventive Services Task Force recommends against screening for asymptomatic bacteriuria in nonpregnant adults (NEJM JW Womens Health Nov 2019

Prevalence of Asymptomatic Bacteriuria among Pregnant Women At Damietta Governorate, Egypt

Background:Asymptomatic bacteriuria during pregnancy is a main health problem, which is related to an increased risk of maternal and fetal morbidity. Aim of the Work:To estimate incidence of asymptomatic bacteriuria among pregnant females at Damietta Governorate, Egypt. Patients and Methods:Five hundred randomly selected pregnant females attending antenatal care units at Damietta Governorate during the period July, first, 2019 – January 31st, 2021. All participants were subjected to full history taking, complete blood count as well as urine culture and bacterial count. Result:A relatively high incidence of asymptomatic bacteriuria [13.8%] was revealed among participants in whom the most causative organism was Escherichia coli. The rate was lower among pregnant women with a high social standard and during the first trimester. Maternal age, parity, education level, or hemoglobin level, on the other hand, had no significant relationship . Conclusion: Screening of asymptomatic bacteriuria in pregnancy must be added to routinely antenatal care investigations and doing another studies on a wider scope are recommended.

Asymptomatic Bacteriuria in Post Renal Transplant Patients: To Treat or Not?

Urinary tract infections (UTIs) can commonly occur within the first few weeks following kidney transplantation procedures. Although the management of asymptomatic bacteriuria and acute graft pyelonephritis is important to reduce the risk of graft rejections following kidney transplantation, the efficacy of antibiotics administration remains controversial among studies in the literature. The aim of this review is to elaborate more on asymptomatic bacteriuria following kidney transplantation and try to formulate proper evidence about the efficacy of antibiotics administration on eliminating the frequency of infections and enhancing the quality of care for patients. Most studies in the literature are observational, which are usually biased in the interventions. However, the current evidence regarding the management and screening of asymptomatic bacteriuria seems to discourage such an approach. Almost all of the included studies reported that antibiotic administration did not significantly lower the rates of secondary symptomatic UTIs or enhance the functions of the graft. In addition, there is no significant impact on mortality and other clinical outcomes. Lastly, the frequent administration of antibiotics can significantly increase the risk of recurrence due to the emergence of novel strains of bacteria that are resistant to the currently administered antibiotics making it unfavorable.

The clinical utility of intrapartum screening urinalysis for the prevention of postpartum pyelonephritis

ObjectivesUrinary tract infection (UTI) is the most common bacterial infection to complicate pregnancy. Medical authorities recommend screening for asymptomatic bacteriuria (ASB) in pregnancy; albeit there is no consensus on ideal timing and frequency for testing. Due to the persistent physiologic changes of pregnancy postpartum, a recent trend to perform urinalysis upon presentation for delivery has been adopted at our institution and various satellite hospitals to putatively minimize cases of postpartum pyelonephritis. The aim of this study is to examine whether routine testing with urinalysis and screening for ASB following suspicious urinalysis with treatment can decrease the incidence of postpartum pyelonephritis, and to determine whether certain urinalysis parameters are more predictive of a positive urine culture. Study designA retrospective chart review study of all term deliveries was conducted over two years at the American University of Beirut Medical Center, a university teaching hospital. A total of 2359 deliveries of women with no increased susceptibility to UTIs were reviewed. None had urinary symptoms upon presentation. Urinary parameters including time of urinalysis and urine culture collection with respect to time of delivery, corresponding results and mode of urine collection were correlated to intrapartum course, incidence of ASB and of postpartum pyelonephritis. ResultsThe incidence of ASB among women presenting for delivery was 4.83 %, with Escherichia coli as the most commonly detected pathogen. The presence of nitrite on urinalysis was significantly associated with a positive urine culture (p-value<0.001). Women with history of antenatal ASB or UTI were more likely to have ASB intrapartum with an odds ratio of 3.14 (95 % CI 1.71–5.75, p-value <0.001). Intrapartum urinalysis with subsequent diagnosis and treatment of ASB did not significantly affect the incidence of postpartum pyelonephritis (p-value 0.280). Similarly, intrapartum urinalysis in the setting of positive history of antenatal ASB or UTI did not increase the incidence of postpartum pyelonephritis compared to women with no such history (p-value 0.659). ConclusionsUrinalysis screening intrapartum does not decrease the incidence of postpartum pyelonephritis. Universal urinalysis screening intrapartum is not warranted and should be reserved for women reporting urinary symptoms and/or women at high risk of UTI.

Effectiveness of antenatal screening of asymptomatic bacteriuria in reduction of prematurity and low birth weight: Evaluating a point-of-care rapid test in a pragmatic randomized controlled study.

BackgroundPremature babies suffer higher mortality and life-long disabilities. Asymptomatic bacteriuria (ASB) is postulated to induce preterm labor. Routine antenatal screening for ASB using urine culture is not feasible in most developing countries due to long turn-around time, user-unfriendliness, and lack of resources. The current parallel-group superiority pragmatic randomized controlled trial evaluated the effect of screening and evidence-based treatment of ASB using an optical-sensor-based point-of-care rapid-test on the incidence of preterm birth and low birthweight (LBW).Methods240 consenting asymptomatic pregnant women visiting an Indian tertiary public hospital for first antenatal check-up, irrespective of trimester/gravida, who had not consumed antibiotics in the preceding week, were enrolled from February-May 2017. Computer-generated concealed simple randomization allocation sequence was used to assign participants to intervention (120) and control arm (120). Usual hospital-care was provided in the control arm. In the intervention arm, urine samples were additionally screened for ASB using the rapid-test and the positive women were prescribed susceptible antibiotics. Blinded outcome assessors followed up with women post-delivery. The study was registered with the Clinical Trials Registry-India (CTRI/2016/09/007240).Findings213 participants were analyzed (intervention: 103, control: 110). 21 women were found positive for ASB and prescribed pathogen-specific antibiotics. The incidence of preterm birth/LBW in intervention arm (n = 27) was lower than control arm (n = 45) by 14·7% (95% CI: 2·2–27·2); RR: 0.64, (95% CI: 0·43–0·95); p = 0·023, X2=5·13.InterpretationRapid-test-guided treatment for ASB reduced the incidence of preterm birth/LBW in a pragmatic setting without any adverse event.FundingDepartment of Biotechnology, Government of India.

Introduction of screening for asymptomatic bacteriuria using multireagent urine dipsticks in antenatal care: Implementation experience from India

Introduction of screening for asymptomatic bacteriuria using multireagent urine dipsticks in antenatal care: Implementation experience from India

Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran.

Background Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs). Aims To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains. Methods Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens. Results Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33–6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07–3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly.

The Utilization and Costs of USPSTF Grade D Services in Medicare, 2007‐2016

Research ObjectiveLow‐value care (LVC), or patient care that offers no net benefit in specific clinical scenarios, leads to unnecessary spending and patient harm in certain circumstances. The U.S. Preventive Services Task Force (USPSTF) Grade D Recommendations exemplify LVC, given the very high certainty that the expected clinical benefits of these services do not exceed the expected harms. We estimate the utilization and related costs of ten USPSTF Grade D Services among U.S. Medicare beneficiaries.Study DesignWe conducted a cross‐sectional analysis of data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of U.S. outpatient visits. NAMCS uses a multistage probability sampling design, and data are abstracted directly from the medical record. Eligible visits included those by beneficiaries 18 years of age or older for whom Medicare was listed as the primary expected payer. Ten USPSTF Grade D Services were selected based on feasibility of case identification using diagnosis codes and recorded symptoms. These included the following: (1) cervical cancer screening for women older than 65, (2) prostate cancer screening for men 75 and older, (3) colonoscopy for adults older than 85, (4) vitamin D screening, (5) screening for cardiovascular disease among low‐risk adults, (6) COPD screening among asymptomatic adults, (7) screening for asymptomatic bacteriuria, (8) vitamin D supplementation for primary prevention of fractures among postmenopausal women, (9) hormone therapy for primary prevention of chronic conditions among postmenopausal women, and (10) vitamin E or beta‐carotene supplements for primary prevention of cardiovascular disease or cancer. The annual volume of these services was determined and then multiplied by per unit costs obtained from separate claims and actuarial sources to calculate annualized costs.Population StudiedOffice‐based visits by Medicare beneficiaries, 2007 to 2016.Principal FindingsFor the 10 services measured, over 30 million were provided to Medicare beneficiaries annually. The direct costs ranged from $649,604,514 to $862,159,707 annually. The three most frequently used services were (1) screening for asymptomatic bacteriuria, (2) vitamin D supplementation, and (3) screening for vitamin D deficiency screening, comprising 83% of the measured services and 46% of the calculated LVC spending. Three services (1) screening for asymptomatic bacteriuria, (2) cervical cancer screening among women older than 65, and (3) colonoscopies among adults older than 85 comprised 53% of measured LVC spending.ConclusionsThe USPSTF provides a D rating for services for which there is a moderate or high certainty that the service has no benefits or that the harms outweigh the benefits. Ten Grade D Services were provided frequently to Medicare beneficiaries, costing nearly $1 billion in Medicare spending annually. The negative clinical impact and total costs associated with the use of D‐rated services are likely larger as these findings do not capture all D‐rated services, as well as the downstream health care utilization after their use.Implications for Policy or PracticeThe implementation of policies that reduce LVC use offers an important opportunity to improve patient‐centered outcomes while safely reducing U.S. health care spending. Resultant savings could be used to expand access to high‐value care using value‐based insurance design.Primary Funding SourceThis study was supported by the Department of Veterans Affairs.