The CBIC Certified Infection Control Exam Study Guide (6th edition) clearly distinguishes true infection from pseudo-infection and colonization, particularly when interpreting urine culture results. A pseudo-infection refers to a positive laboratory result that does not represent a true clinical infection and is often associated with asymptomatic bacteriuria, specimen contamination, or improper collection.
When a patient has a positive urine culture but reports no urinary or systemic symptoms, the most accurate interpretation is that the finding represents colonization or a pseudo-infection rather than a true urinary tract infection (UTI). The Study Guide emphasizes that UTIs must meet both microbiologic and clinical criteria. Symptoms such as dysuria, urinary frequency, urgency, suprapubic tenderness, flank pain, or costovertebral angle tenderness are required to support a diagnosis of infection.
Options A, C, and D all describe symptoms consistent with upper or lower urinary tract infection and therefore suggest true infection rather than pseudo-infection. In contrast, the absence of symptoms strongly supports a diagnosis of asymptomatic bacteriuria or pseudo-infection, for which antimicrobial treatment is generally not indicated, except in specific populations (e.g., pregnant patients or those undergoing urologic procedures).
Recognizing pseudo-infection is critical for antimicrobial stewardship, prevention of unnecessary antibiotic use, and accurate infection surveillance—key competencies tested on the CIC® exam.
