American Board of Internal Medicine (ABIM) Certification Practice Exam

What two indications support the treatment of asymptomatic bacteriuria?

1. Pregnancy and recent urinary tract infection

2. Pregnancy and medical clearance for invasive urologic procedure

3. Medical clearance before surgery and patient request

4. History of kidney stones and pregnancy

The correct answer is: Pregnancy and medical clearance for invasive urologic procedure

The correct choice emphasizes the importance of treating asymptomatic bacteriuria in specific clinical contexts, particularly during pregnancy and when preparing for invasive urologic procedures. In pregnancy, asymptomatic bacteriuria should be treated because it poses a risk for progression to symptomatic urinary tract infections (UTIs), which can lead to complications such as preterm labor and low birth weight. The recognition of this increased risk underlines the need for effective management in pregnant patients. In the context of medical clearance for an invasive urologic procedure, treating asymptomatic bacteriuria is essential to prevent potential postoperative complications. Procedure-related trauma can facilitate bacteremia or further infection, so ensuring that the urinary tract is free of significant bacterial presence is crucial for patient safety. While other options may present scenarios where treatment could be considered—such as recent urinary tract infections or the desire for patient requests—these situations do not hold the same clinical weight in terms of established guidelines supporting intervention. The focus on pregnancy and invasive procedures is grounded in the evidence reflecting the potential for serious adverse outcomes associated with untreated bacteriuria in those contexts.