Final Research Plan
Asymptomatic Bacteriuria in Adults: Screening
December 28, 2017
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.
The draft Research Plan was available for comment from September 28 until October 25, 2017 at 5:00 p.m., ET.
- Does screening for asymptomatic bacteriuria in adults, including pregnant women, improve health outcomes?
- What are the harms of screening for asymptomatic bacteriuria in adults, including pregnant women?
- Does treatment of screen-detected, asymptomatic bacteriuria improve health outcomes?
- What are the harms of treatment of screen-detected, asymptomatic bacteriuria?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What is the accuracy of onsite clinical screening tests for asymptomatic bacteriuria?
- What is the optimal timing and frequency of screening for asymptomatic bacteriuria in pregnant women?
- What is the association between asymptomatic bacteriuria and health outcomes?
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).
|Populations||KQs 1, 2: Unselected, asymptomatic, community-dwelling adults age ≥18 years (including those residing in independent living facilities)
KQs 3, 4: Community-dwelling adults age ≥18 years with asymptomatic bacteriuria (including those residing in independent living facilities); unselected, asymptomatic pregnant women receiving routine prenatal care (any age)
|Interventions||KQs 1, 2: Screening with urine testing (e.g., urine culture, urinalysis with microscopy, dipstick, dipslide, screening with reflex urine culture)
KQs 3, 4: Treatment (e.g., antibiotics) or interventions to prevent urinary tract infection in patients with screen-detected, asymptomatic bacteriuria
|Interventions to prevent asymptomatic bacteriuria|
|Comparisons||KQ 1: No screening
KQ 3: No treatment; treatment with a placebo
|Outcomes||KQs 1, 3:
General health outcomes:
|Setting||Prenatal or primary care settings||Studies conducted exclusively in populations living in special settings outside of the community (e.g., hospital, nursing or care home, rehabilitation center, or other long-term care facility), emergency departments, and other settings not generalizable to primary care|
|Study Design||KQs 1, 3:
Nonpregnant adults: RCTs
Pregnant women*: RCTs, observational cohort studies with a comparator of no screening or no treatment
KQs 2, 4: RCTs, observational cohort studies with and without a comparison group, registry studies
|KQs 1, 3:
Nonpregnant adults: Study designs other than RCTs
Pregnant women*: Study designs other than RCTs or observational cohort studies with a comparator of no screening or no treatment
KQs 2, 4: Case control studies, case series and case reports, qualitative studies
|Countries||Nonpregnant adults: Studies conducted in countries categorized as “Very High” on the 2016 Human Development Index (as defined by the United Nations Development Programme)
Pregnant women*: Studies conducted in countries categorized as “Very High” and “High” on the 2016 Human Development Index
|Nonpregnant adults: Studies not conducted in countries categorized as “Very High” on the 2016 Human Development Index
Pregnant women*: Studies not conducted in countries categorized as “Very High” or “High” on the 2016 Human Development Index
|Publication language||English||Languages other than English|
*The inclusion criteria for studies of screening for and treatment of asymptomatic bacteriuria in pregnant women are more broad because prior evidence from trials and ensuing recommendations have established a standard practice of screening and treatment.
Abbreviations: HELLP=hemolysis, elevated liver enzymes, low platelet count; RCT=randomized, controlled trial.
The draft Research Plan was posted for public comment on the USPSTF Web site from September 28, 2017 to October 25, 2017. In response, the USPSTF made minor changes to clarify the included population and relevant outcomes. Several comments suggested that screening for asymptomatic bacteriuria may be important for patients in long-term care institutional care settings or with indwelling catheters. The evidence review will focus on community-dwelling adults presenting in primary care settings rather than institutionalized populations, in accordance with the usual scope of USPSTF recommendations. Some comments expressed concern that antibiotic treatment of asymptomatic bacteriuria could contribute to the emergence of antibiotic-resistant infections; the USPSTF included this potential harm to the included outcomes for the evidence review.