The quality of evidence (I-III) and classification of recommendations (A-L) are defined at the end of the "Major Recommendations."
Maternal And Perinatal Risks Associated With Any Asymptomatic Bacteriuria In Pregnancy
- Treatment of any bacteriuria with colony counts ≥100,000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. (II-2A)
Maternal And Perinatal Risks Associated With Asymptomatic Group B Streptococcal (GBS) Bacteriuria In Pregnancy
- Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the time of labour or rupture of membranes with appropriate intravenous antibiotics for the prevention of early-onset neonatal group B streptococcal disease. (II-2A)
Risk of Neonatal GBS Disease
- Asymptomatic women with urinary group B streptococcal colony counts <100,000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth. (II-2E)
No Indication For Third Trimester Re-Screening For GBS Colonization
- Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. (II-2D)
Quality of Evidence Assessment*
I: Evidence obtained from at least one properly randomized controlled trial
II-1: Evidence from well-designed controlled trials without randomization
II-2: Evidence from well–designed cohort (prospective or retrospective) or case–control studies, preferably from more than one centre or research group
II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
*Adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.
Classification of Recommendations†
A. There is good evidence to recommend the clinical preventive action.
B. There is fair evidence to recommend the clinical preventive action.
C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making.
D. There is fair evidence to recommend against the clinical preventive action.
E. There is good evidence to recommend against the clinical preventive action.
L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making.
†Adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.