Which of the following populations should be screened for asymptomatic bacteriuria?

Explanation

Core Concept:

Asymptomatic bacteriuria (ASB) refers to the presence of bacteria in the urinary tract without symptoms of a urinary tract infection. In pregnant women, physiological changes increase the risk of ascension to pyelonephritis, making screening and treatment uniquely vital.

Clinical Presentation:

• Symptoms: Completely absent (asymptomatic).
• Complications: Progression to acute pyelonephritis, premature rupture of membranes, preterm labor, and low birth weight infants.

Diagnosis:

• First-line: Urine dipstick screening test for leukocyte esterase and nitrites.
• Gold Standard: Quantitative urine culture showing ≥ 10^5 colony-forming units (CFU)/mL of a single uropathogen from a clean-catch midstream urine specimen.

Management:

• Acute: Prompt initiation of targeted oral antibiotic therapy (e.g., nitrofurantoin, cephalexin, or amoxicillin-clavulanate) based on urine culture sensitivities.
• Definitive/Long-term: Complete antibiotic course followed by test-of-cure urine cultures to ensure eradication and prevent recurrence throughout gestation.