大人の無症状バクテリア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勧告声明
, Douglas K Owens1,2, Karina W Davidson3
1Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
JAMA
|September 25, 2019
まとめ
尿培養による無症状のバクテリアウリアの検診は,胎内合併症の予防に適度な利点をもたらします. しかし,妊娠していない成人のスクリーニングは,利益よりも潜在的な害が大きいため推奨されません.
科学分野:
- 内科 医学
- 産婦人科
- 感染症
背景:
- 症状のないバクテリアウリア (ASB) は,特に女性では一般的であり,妊娠中の重篤な状態であるピエロネフリトにつながる可能性があります.
- 妊娠中のピエロネフリスは,セプシミアと早産を含む母親と胎児の有害な結果と関連しています.
研究 の 目的:
- 成人と妊婦の無症状バクテリア尿のスクリーニングと治療に関する勧告を更新する.
- ASBのスクリーニングと治療の利害を評価する.
主な方法:
- 証拠の体系的なレビューは,米国の予防サービスタスクフォース (USPSTF) によって委託されました.
- このレビューは,尿路感染症の症状のない妊婦および非妊婦のASBのスクリーニングと治療の利益と害に焦点を当てた.
主要な成果:
- 妊娠中のASBのスクリーニングと治療は,中程度の純利益があり,生後合併症とピエロネフライトの発生率を減少させます.
- 微生物群の変化を含む抗生物質治療による害は少なくとも小さいことが判明しました.
- 妊娠していない成人のASBのスクリーニングと治療は,治療による害は少なくとも小さいと考えられ,純利益を示さなかった.
結論:
- USPSTFは,尿培養を用いてASBのスクリーニングを行うことを推奨しています (B勧告).
- USPSTFは,妊娠していない成人をASB (D推奨) のスクリーニングしないよう推奨しています.
関連する概念動画
01:26Urinary Tract Infection I: Introduction
Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
01:25Urinary Tract Infection II: Pathophysiology
The pathophysiology of urinary tract infections (UTIs) encompasses several progressive stages, beginning with bacterial colonization and culminating in potential systemic complications if untreated. UTIs are primarily initiated by bacteria, such as Escherichia coli, which often originate from the gastrointestinal tract and migrate to the urinary system through the periurethral area. This migration can occur via several routes, including improper hygiene practices, sexual activity, or...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
01:17Urinary Tract Infection IV: Nursing Management
In managing urinary tract infections (UTIs) in nursing, a comprehensive assessment is essential. Begin by gathering subjective data, such as the patient’s complaints of dysuria (painful urination), urinary frequency, urgency, suprapubic pain, and any lower abdominal discomfort. This information can be complemented by questions regarding previous UTIs, sexual activity, and personal hygiene practices, which can provide insight into risk factors. Objective assessment should focus on signs like...
01:26Urine Studies II: Urine Culture and Sensitivity Test
A urine culture and sensitivity test is a diagnostic procedure used to identify urinary tract bacterial infections and determine the most effective antibiotics for treatment. This test is generally preferred when a patient shows manifestations of a urinary tract infection, such as frequent or painful urination, cloudy or foul-smelling urine, or lower abdominal pain.Purpose of the TestThe primary goals of a urine culture and sensitivity test are to:Determine the specific bacteria causing the...
01:28Microbiota of the Urogenital Tract
The human urogenital system, once thought to be sterile in healthy individuals, is now recognized as a complex microbial habitat. Advancements in molecular sequencing techniques have revealed that even in healthy adults, the kidneys and bladder harbor microbial populations similar to those found in the distal urethra, albeit in much lower abundance. These resident microorganisms, while generally innocuous, can become opportunistic pathogens under conditions that alter the urogenital...