Asymptomatic bacteriuria in low-risk pregnancy - what is the evidence of its treatment?
DOI:
https://doi.org/10.5712/rbmfc14(41)1922Keywords:
Bacteriuria, Pregnancy, Premature Birth, Primary Health CareAbstract
Asymptomatic bacteriuria (ASB) has been associated with an increased risk of maternal pyelonephritis (PN) and preterm birth (PTB). International clinical guidelines recommend its research and treatment during pregnancy. However, the benefit and risk of screening and treating ASB is not consensual, and this review intends to analyze the available evidence regarding the influence of ASB treatment on maternal and fetal morbidity and mortality. We search on MEDLINE database and Evidence-Based Medicine sites of evidence-based reviews, clinical guidelines, meta-analysis, systematic reviews and randomized controlled trials, using the MeSH terms “Bacteriuria AND Pregnancy”, of articles published between January 2008 and May 2018, in English, French, Spanish and Portuguese. The Strength of Recommendation Taxonomy (SORT) scale of the American Family Physician was used to assess the levels of evidence and assignment of recommendation forces. We identified 136 articles, of which ten met the inclusion criteria. The existing evidence, mostly based on outdated or small and with methodological shortcomings clinical trials, does not allow a clear conclusion as to whether the treatment of ASB positively influences maternal and fetal morbidity and mortality; the most recent data effectively points to a lack of benefit with ASB treatment (SOR B). To address the limitations of the studies found, controlled, randomized, higher quality and larger studies are needed to assess the influence of ASB treatment on maternal and fetal morbidity and mortality.
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Direcção Geral de Saúde. Norma no 037/2011, de 30/09/2011. atualizada em 20/12/2013. [acesso 2018 Jun 20]. Disponível em: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0372011-de-30092011.aspx
Bonkat G, Bartoletti RR, Bruyère F, Cai T, Geerlings SE, Köves B, et al.; European Association of Urology. Urological infections. Arnhem: European Association of Urology; 2018. [acesso 2018 Jun 20]. Disponível em: http://uroweb.org/guideline/urological-infections/
American Academy of Pediatrics Committee on Fetus and Newborn/American College of Obstetricians and Gynaecologists Committee on Obstetric Practice, Guidelines for Perinatal Care 7th ed. Elk Grove Village/Washington: American Academy of Pediatrics/American College of Obstetricians and Gynaecologists; 2013.
Allen VM, Yudin MH; Infectious Diseases Committee. Management of group B streptococcal bacteriuria in pregnancy. J Obstet Gynaecol Can. 2012;34(5):482-86. https://doi.org/10.1016/S1701-2163(16)35246-X DOI: https://doi.org/10.1016/S1701-2163(16)35246-X
Scottish Intercollegiate Guidelines Network. Management of suspected bacterial urinary tract infection in adults. Edinburgh: Scottish Intercollegiate Guidelines Network; 2012.
U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008;149(1):43-7. https://doi.org/10.7326/0003-4819-149-1-200807010-00009 DOI: https://doi.org/10.7326/0003-4819-149-1-200807010-00009
National Institute for Health and Clinical Excellence: Guidance. Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press; 2008.
Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2015;(8):CD000490. https://doi.org/10.1002/14651858.CD000490.pub3 DOI: https://doi.org/10.1002/14651858.CD000490.pub3
Angelescu K, Nussbaumer-Streit B, Sieben W, Scheibler F, Gartlehner G. Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review. BMC Pregnancy Childbirth. 2016;16(1):336. https://doi.org/10.1186/s12884-016-1128-0 DOI: https://doi.org/10.1186/s12884-016-1128-0
Köves B, Cai T, Veeratterapillay R, Pickard R, Seisen T, Lam TB, et al. Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. Eur Urol. 2017;72(6):865-8. https://doi.org/10.1016/j.eururo.2017.07.014 DOI: https://doi.org/10.1016/j.eururo.2017.07.014
Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de Miranda E, et al. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis. 2015;15(11):1324-33. https://doi.org/10.1016/S1473-3099(15)00070-5 DOI: https://doi.org/10.1016/S1473-3099(15)00070-5
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