Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review

Angelescu, Konstanze; Nussbaumer-Streit, Barbara; Sieben, Wiebke; Scheibler, Fülöp; Gartlehner, Gerald

doi:10.1186/s12884-016-1128-0

BMC Pregnancy and Childbirth

Table 4 Results

From: Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review

Outcome measure	Study	Treatment group		Control group		Difference between groups
Specification		N	Events (%)	N	Events (%)	OR [95 % CI]; p-value
Pyelonephritis
	Kazemier [21]	40	0 (0)	45	1 (2.2)	0.37^a [0.01; 9.25]^a; 0.515^b
	Williams [22]	85^c	5 (6)	78^c	18 (23)	0.21^a [0.07–0.59]^a; 0.002^b
Lower UTI
Treated with AB during pregnancy	Kazemier [21]	40	4 (10)	45	8 (18)	POR 0.53^a [0.16; 1.79]^a; 0.357^b
Recurrent UTI treated with AB during pregnancy	Kazemier [21]	40	0 (0)	45	1 (2.2)	0.37^a [0.01; 9.25]^a; 0.515^b
Treated with AB postpartum (within 6 weeks)	Kazemier [21]	40	3 (7.5)	45	1 (2.2)	POR 3.20^a [0.43; 23.63]^a; 0.296^b
Pre- and post-partal^d	Mulla [20]	50	3 (6)	50	20 (40)	0.10^a [0.03–0.35]^a; < 0.001^b
Preterm birth
< 37 weeks^e	Kazemier [21]	40	2^f (5)	45	2 (4.4)	POR 1.13^a [0.15; 8.35]^a; 0.975^b
< 32 weeks	Kazemier [21]	40	1 (2.5)	45	0 (0)	3.46^a [0.14; 87.26]^a; 0.357^b
Infant morbidity
Kernicterus	Elder [19]	54	0^g	52	0^g	n. a.
Composite severe morbidity^h	Kazemier [21]	40	0 (0)	45	2 (4.4)	0.21^a [0.01; 4.61]^a; 0.220^b
Admission to NICU	Kazemier [21]	40	2 (5)	45	0 (0)	5.91^a [0.28; 126.85]^a; 0.169^b
Neonatal sepsis confirmed with culture	Kazemier [21]	40	0 (0)	45	2 (4.4)	0.21^a [0.01; 4.61]^a; 0.220^b
Congenital abnormalities	Kazemier [21]	40	0 (0)	45	1 (2.2)	0.37^a [0.01; 9.25]^a; 0.515^b
Infant mortality
Perinatal death	Kazemier [21]	40	1 (2.5)	45	0 (0)	3.46^a [0.14; 87.26]^a; 0.357^b
Adverse events
Vomiting	Elder [19]	54	1	52	0	n. a.
Rashes, pruritus	Elder [19]	54	0^f	52	0^f	n. a.
Photosensitivity	Elder [19]	54	0^f	52	0^f	n. a.
Discontinuations due to adverse events	Mulla [20]	50	0	50	0	n. a.
Pre-eclampsia^e	Kazemier [21]	40	2 (5)	45	1 (2.2)	POR 2.24^a [0.23; 22.22]^a; 0.596^b
HELLP syndrome	Kazemier [21]	40	2 (5)	45	0 (0)	5.91^a [0.28; 126.85]^a; 0.169^b
Kidney stones, cholestasis	Kazemier [21]	40	0 (0)	45	0 (0)	RD 0 [-9,4; 10,5]
Thrombo-embolic events	Kazemier [21]	40	0 (0)	45	0 (0)	RD 0 [-9,4; 10,5]
Endometritis (within 6 weeks of delivery)	Kazemier [21]	40	0 (0)	45	0 (0)	RD 0 [-9,4; 10,5]
Mastitis (within 6 weeks of delivery)	Kazemier [21]	40	1 (2.5)	45	1 (2.2)	POR 1.13^a [0.07; 18.41]^a; 0.997^b

AB antibiotics, CI confidence interval, CSZ convexity, symmetry, z score, HELLP haemolysis, elevated liver enzymes, low platelet count syndrome, n. a not available, NICU Neonatal Intensive Care Unit, OR odds ratio, POR Peto odds ratio, RD risk difference, UTI urinary tract infection
^aIQWiG’s own calculation
^bIQWiG’s own calculation, unconditioned exact test (CSZ method as described in [25])
^cNumber of participants analysed; number of randomised participants not stated
^dThe outcome was named either cystopyelitis or symptomatic UTI; neither term was defined. It was therefore unclear which stage of UTI the reported outcome represented. Following a conservative approach, we classified the outcome as lower UTI. However, it is possible that cases of upper UTI were also included
^eConsidered a non-patient-relevant outcome
^fOne event is also included in preterm births < 32 weeks
^gIt is unclear whether the reported event rate relates to both study groups; alternatively, the event rate may relate solely to the treatment group or to any pregnant participant with or without bacteriuria
^hRespiratory distress syndrome, necrotizing enterocolitis, intraventricular haemorrhage, bronchopulmonary disease, sepsis

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ISSN: 1471-2393

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