成人における無症状のバクテリウリアのスクリーニング:米国予防サービスタスクフォースの最新証拠報告と体系的レビュー
Jillian T Henderson1, Elizabeth M Webber1, Sarah I Bean1
1Center for Health Research, Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente, Portland, Oregon.
JAMA
|September 25, 2019
まとめ
妊娠中の女性における無症状細菌尿 (ASB) のスクリーニングは,ピエロネフライトと低出生体重を減少させる可能性があります. しかし,ASB治療は,妊娠していない成人に有益な効果を示せず,有害性に関する証拠は限られている.
科学分野:
- 泌尿器科
- 感染症
- 予防 医療
背景:
- 無症状の細菌尿 (ASB) のスクリーニングは,感染を予防するための治療から恩恵を受ける患者を特定することができます.
- 米国予防サービスタスクフォースは ASBのスクリーニングと治療の利益と害について 体系的なレビューを要求しています
研究 の 目的:
- 妊婦を含む成人のASBスクリーニングと治療の利害を体系的に検討する.
- 予防サービス・タスク・フォースの指針を提示する.
主な方法:
- ランダム化臨床試験 (RCT) とASBのスクリーニングと治療に関する観察研究をMEDLINE,PubMed,Cochrane Libraryで検索しました.
- 選択されていない無症状の個体での利益と害に関する研究が含まれています.
- ランダムな効果によるメタ分析を実施した.
主要な成果:
- 2つのコホート研究では,スクリーニングを受けた妊婦のピエロネフライトの減少を示した (RR0. 30).
- 12件の試験では,妊娠中のASBスクリーニングと治療により,ピエロネフリスの減少 (RR 0. 24) と低出生体重 (RR 0. 64) が示されました.
- 5つのRCTでは,妊娠していない成人のASB治療の有意な利点が見つかりませんでした.
結論:
- ASBのスクリーニングと妊娠中の治療は 皮エロネフライトと低出生体重を減少させたが,証拠は古い.
- 妊娠していない成人の場合,ASB治療の利点は認められなかった.
- ASBのスクリーニングと治療の害に関する証拠は限られている.
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