Detection of asymptomatic bacteriuria in obstetric patients with a semiautomated urine screen

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Abstract

Urine specimens (1215) from obstetric patients were evaluated for the presence of significant bacteriuria by the Bac-T-Screen (Marion Scientific Division, Marion Laboratories, Inc., Kansas City, Missouri) and a conventional semiquantitative culture method. Seventy (5.8%) specimens were not processed successfully by the Bac-T-Screen because pigments interfered with interpretation or the test filters clogged. The remaining 1145 specimens screened by the Bac-T-Screen were compared with a conventional culture method. The sensitivity, specificity, positive predictive value, and negative predictive value for specimens containing ≥ 105 colony-forming units per milliliter were 97.4%, 70.4%, 19.0%, and 99.7%, respectively. These values for specimens containing ≥104 colony-forming units per milliliter were 92.2%, 71.6%, 24.1%, and 98.9%, respectively.

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      There is no evidence to recommend that laboratories provide a gram stain of either a centrifuged or uncentrifuged urine as a simple test to screen for asymptomatic bacteriuria in pregnancy. A semi-automated screen (Bac-T screen) showed high sensitivity and negative predictive value but low specificity and positive predictive values, and often technical problems interfered with the interpretation of the results.51,56 Authors of prospective studies evaluating a rapid enzymatic urine screening test have concluded that its low sensitivity also makes it inadequate for rapid screening in pregnancy57,58, and neither of these tests can be recommended for routine use.

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