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Asymptomatic bacteriuria in pregnancy — CCFP MCQ

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HardPreventive care and screeningAsymptomatic bacteriuria in pregnancyCCFP

A 39-year-old pregnant patient with no urinary symptoms has routine urine culture at 11 weeks showing 10⁵ CFU/mL E. coli. She has no fever, dysuria or flank pain. What is the most appropriate management?

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Correct answer: C — Initiate pregnancy-appropriate antibiotic therapy and confirm eradication with follow-up culture

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · E = shown as D · C = shown as E

The Canadian Task Force on Preventive Health Care and current CMAJ guidance (2018) establish that screened asymptomatic bacteriuria in pregnancy should be treated with pregnancy-safe antibiotics. The patient's quantitative culture (10⁵ CFU/mL E. coli) at 11 weeks meets the threshold and timing for intervention. Untreated ASB carries a documented 40% risk of progression to pyelonephritis and is associated with preterm birth and low birth weight. Treatment reduces pyelonephritis rates to 0.5% versus 2.2% in unscreened cohorts. Fluoroquinolones (D) are avoided in pregnancy; structural imaging (C) is not part of routine ASB management; deferral until complications (E) negates preventive intent. Confirmation of eradication is standard practice.

Reference: Canadian Task Force on Preventive Health Care. Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ. 2018;190(27):E823–E830. https://www.cmaj.ca/content/190/27/E823