Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic reviewReportar como inadecuado




Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Pregnancy and Childbirth

, 16:336

Maternal health and pregnancy

Abstract

BackgroundMost European and North American clinical practice guidelines recommend screening for asymptomatic bacteriuria ASB as a routine pregnancy test. Antibiotic treatment of ASB in pregnant women is supposed to reduce maternal upper urinary tract infections upper UTIs and preterm labour. However, most studies supporting the treatment of ASB were conducted in the 1950s to 1980s. Because of subsequent changes in treatment options for ASB and UTI, the applicability of findings from these studies has come into question. Our systematic review had three objectives: firstly, to assess the patient-relevant benefits and harms of screening for ASB versus no screening; secondly, to compare the benefits and harms of different screening strategies; and thirdly, in case no reliable evidence on the overarching screening question was identified, to determine the benefits and harms of treatment of ASB.

MethodsWe systematically searched several bibliographic databases, trial registries, and other sources up to 02-2016 for randomised controlled trials RCTs and prospective non-randomised trials. Two authors independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. As meta-analyses were not possible, we summarised the results qualitatively.

ResultsWe did not identify any eligible studies that investigated the benefits and harms of screening for ASB versus no screening or that compared different screening strategies. We identified four RCTs comparing antibiotics with no treatment or placebo in 454 pregnant women with ASB. The results of 2 studies published in the 1960s showed a statistically significant reduction in rates of pyelonephritis odds ratio OR = 0.21, 95 % confidence interval CI 0.07–0.59 and lower UTI OR = 0.10, 95 % CI 0.03–0.35 in women treated with antibiotics. By contrast, event rates reported by a recent study were not statistically significantly different, neither regarding pyelonephritis 0 % vs. 2.2 %; OR = 0.37, CI 0.01–9.25, p = 0.515 nor regarding lower UTI during pregnancy 10 % vs. 18 %; Peto odds ratio POR = 0.53, CI 0.16–1.79, p = 0.357. Data were insufficient to determine the risk of harms. As three of the four studies were conducted several decades ago and have serious methodological shortcomings, the applicability of their findings to current health care settings is likely to be low. The recent high-quality RCT was stopped early due to a very low number of primary outcome events, a composite of preterm delivery and pyelonephritis. Therefore, the results did not show a benefit of treating ASB.

ConclusionsTo date, no reliable evidence supports routine screening for ASB in pregnant women.

KeywordsMass Screening Bacteriuria Pregnancy Benefit Assessment Systematic Review AbbreviationsASB+Positive for asymptomatic bacteriuria

CCTControlled clinical trial

HTAHealth technology assessment

RCTRandomised controlled trial

Electronic supplementary materialThe online version of this article doi:10.1186-s12884-016-1128-0 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Autor: Konstanze Angelescu - Barbara Nussbaumer-Streit - Wiebke Sieben - Fülöp Scheibler - Gerald Gartlehner

Fuente: https://link.springer.com/







Documentos relacionados