Evaluation of reagent strips in detecting asymptomatic bacteriuria in early pregnancy: prospective case series

Abstract Objective: To evaluate the performance of reagent test strips in screening pregnant women for asymptomatic bacteriuria at their first visit to an antenatal clinic. Design: Prospective case series. Setting: Antenatal clinic of a large inner city maternity hospital. Subjects: All women attending for their first antenatal clinic. Patients taking antibiotics for any reason and those with urinary tract symptoms were excluded. Intervention: A midstream urine specimen was divided; half was sent for microscopy and formal bacteriological culture and the other half was tested with a commercial reagent strip test for the presence of blood, protein, nitrite, and leucocyte esterase. Main outcome measures: Sensitivity, specificity, and positive and negative predictive values of the reagent strips in diagnosing asymptomatic bacteriuria (defined as 105 colony forming units/ml urine). Results: Sensitivity was low, with a maximum of 33% when all four tests were used in combination. Specificity was high, with typical values of 99% or more. Positive predictive value reached a maximum of 69% and negative predictive value was typically 95% or more. Conclusion: Urine reagent strips are not sufficiently sensitive to be of use in the screening for asymptomatic bacteriuria and therefore many patients would be missed. In view of the potentially serious sequelae of this condition in pregnant women we recommend that formal bacteriological investigation remain the investigation of choice in this group of patients. Key messages Asymptomatic bacteriuria is a potentially serious clinical condition Early antenatal urine screening should identify all cases to ensure adequate treatment Commercially available reagent strips for testing urine do perform to a sufficient standard The cost savings associated with reagent strips cannot be justified in this group of women All patients should have at least one urine specimen formally cultured in early pregnancy to exclude bacteriuria