Background: Urinary tract infections (UTI) in children with sickle cell anemia (SCA) may result in long term morbidity and mortality due to chronic renal dysfunction. Objectives: To evaluate the prevalence of significant bacteriuria among children with SCA and to determine their antimicrobial sensitivity patterns of isolates. Methods: Two hundred and seventy two children with SCA in steady state (n = 185) and in crises (n = 87) aged 6 months to 15 years had their urine samples screened for significant bacteriuria. The urine samples were collected aseptically and incubated aerobically at 37°C for 24 hours. Children whose urine samples yielded ≥10 5 cfu/ ml of bacteria on two consecutive cultures were regarded as having significant bacteriuria. The antimicrobial sensitivity pattern of isolates was determined. Results: Significant bacteriuria was detected in 22 (8.1%) of the 272 subjects, 156 boys (57.4%) and 116 (42.6%) girls. The prevalence of significant bacteriuria was higher among those in crisis, 18 (20.7%) than among those in steady than, 4 (2.2%) state: χ 2 = 27.323, p = 0.001. The most common organism isolated was Escherichia coli, 11 (50.0%). The antibiotic with the best sensitivity was ceftriaxone. Most organisms were resistant to the commonly u s e d a n t ib io t ic s l i ke c otrimoxazole, amoxicillin and ampicillin. Conclusion:The prevalence of significant bacteriuria was found to be higher in SCA subjects in crisis (20.7%) than among those in steady state (2.2%). The most prevalent urinary pathogens were sensitive to ceftriaxone but resistant to commonly used antibiotics.
Abstract:Objective: This study aimed at determining the significance of pyuria as a screening test for UTI in children with sickle cell anaemia (SCA). Methods: Two hundred and seventy-two children with SCA, aged 6 months to 15 years, were studied out of which 185 (68.0%) were in stable state and 87 (32.0%) were in crises. Their urine was assessed for microscopy culture and sensitivity. Significant pyuria and bacteriuria was determined using standard methods. Results: Significant bacteriuria was detected in 22 (8.1%) of the 272 subjects with SCA. The prevalence of significant bacteriuria was higher among those in crisis (18/87; 20.7%) than in those in steady state (4/185; 2.2%) and the difference was statistically significant (χ 2 = 27.323, p = 0.001). Of the 22 SCA subjects with confirmed UTI, 19 (86.4%) had significant pyuria with a sensitivity of 86.4%, specificity of 68.8%, and positive predictive value of 19.6%. The most common bacterial isolates were Escherichia coli 11 (50.0%) while the least isolated were Salmonella typhi 1 (4.6%). Conclusion: This study indicates that pyuria as a screening test for UTI is not very specific but very sensitive necessitating a more test to be done for diagnosis of UTI.
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