PREVALENCE OF ASYMPTOMATIC BACTERIURIA IN CHILDREN WITH SICKLE CELL ANAEMIA AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH), ENUGU

Abstract

Urinary tract infection (UTI) is a common cause of chronic renal disease in children in our environment. This consequence occurs especially when the disease is asymptomatic. The development of chronic or end stage renal disease may be hastened in children with sickle cell anaemia whose renal function may have been compromised by recurrent renal ischaemia ensuing from vaso-occlusion as well as recurrent urinary tract infection. Therefore, the current study was carried out on children with sickle cell anaemia to ascertain the prevalence of asymptomatic bacteriuria. It was also aimed to determine any association between the prevalence rate and socio-economic status, age and sex as well as the pattern of organisms isolated and their antibiotic sensitivity. One hundred children with sickle cell anaemia and 100 children with normal haemoglobin genotype (controls) aged 2-12 years were screened for asymptomatic bacteriuria. The age, sex, and the social classes of the children were obtained and the weight, height, blood pressure, and the axillary temperature of the children were also measured by the researcher. Midstream or ‘clean catch’(for those who are not toilet trained) urine of the children was collected in boric acid containing bottles without prior cleansing of the external genitalia and transported to the microbiology laboratory of the University of Nigeria teaching hospital(UNTH), Enugu in an ice containing box. The urine samples were cultured within four hours of collection. The culture plates were incubated for 24 hours at 370C. Second urine samples was collected from children whose first sample showed significant bacterial growth. Those whose second sample still showed significant bacterial growth were considered to have

asymptomatic bacteriuria. Samples with mixed growth were considered as contaminants and therefore disregarded. The results showed an overall prevalence of asymptomatic bacteriuria of 6% in children with sickle cell anaemia compared with 2% in the controls of comparable age, sex, and socio-economic status. Of the six sickle cell anaemia children with asymptomatic bacteriuria, five (83.3%) were females with one (16.7%) male giving a male: female ratio of 1:5. Among the control group two females had significant bacteriuria. As regards the organisms identified, Escherichia coli was isolated in only two (33.3%) of the six children with sickle cell anaemia and asymptomatic bacteriuria while Staph aureus, Strep faecalis, Staph albus and Proteus species was isolated from each of the remaining four respectively. Among the control group 50% had Streptococcus faecalis and another 50% had Staphylococcus aureus isolated from their urine. Age had no influence on the prevalence of asymptomatic bacteriuria in the subjects and controls. Though social class difference influenced the prevalence of asymptomatic bacteriuria among the subjects occurring more among the higher social groups (p=0.03), the same was not noted in the controls (p=0.79). All the organisms isolated from the subjects and the controls were resistant to cotrimoxazole and ampicillin while most of the organisms were sensitive to gentamicin, nalidixic acid, ceftriaxone, and the quinolones. It is recommended that children with sickle cell anaemia should not be routinely screened for urinary tract infection since there is no significant difference in the prevalence rates of asymptomatic bacteriuria between sickle cell anaemia children and those with normal haemoglobin genotype because routine screening would not be cost effective. However, it is advocated that they be screened for UTI when they present

to the clinics for other medical conditions and those detected at this point be treated appropriately to reduce the morbidity and mortality from these infections. From the findings in this study, it is also recommended that cotrimoxazole and ampicillin should no longer be used as drugs of choice in the empirical treatment of urinary tract infection. It is advised that antibiotics such as ciprofloxacin and ceftriaxone can be used as they have been found to be safe in children but their use should be guided by sensitivity studies.

PREVALENCE OF ASYMPTOMATIC BACTERIURIA IN CHILDREN WITH SICKLE CELL ANAEMIA AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH), ENUGU