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Asymptomatic bacteriuria — ABIM Board MCQ

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EasyInfectious DiseaseAsymptomatic bacteriuriaABIM Board

A 71-year-old woman in a skilled nursing facility has a urine culture obtained for cloudy urine. It grows Escherichia coli greater than 100,000 CFU/mL. She has no dysuria, frequency, suprapubic pain, flank pain, fever, or delirium. Vital signs are normal. Urinalysis shows pyuria. Which of the following is the most appropriate management?

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Correct answer: A — No antibiotic therapy

Asymptomatic bacteriuria, even with pyuria, should not be treated in older nonpregnant adults. Treatment increases adverse events and resistance without clinical benefit.

Reference: IDSA Asymptomatic Bacteriuria Guideline