Asymptomatic bacteriuria in sickle cell disease: a cross-sectional study

Abstract

Background: It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). However, it is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. This study was undertaken to determine the prevalence of ASB, in a cohort of patients with SCD.Methods: This is a cross-sectional study of patients in the Jamaican Sickle Cell Cohort. Aseptically collected mid-stream urine (MSU) samples were obtained from 266 patients for urinalysis, culture and sensitivity analysis. Proteinuria was measured by urine dipsticks. Individuals with abnormal urine culture results had repeat urine culture. Serum creatinine was measured and steady state haematology and uric acid concentrations were obtained from clinical records. This was completed at a primary care health clinic dedicated to sickle cell diseases in Kingston, Jamaica. There were 133 males and 133 females in the sample studied. The mean age (mean ± sd) of participants was 26.6 ± 2.5 years. The main outcome measures were the culture of ≥ 10 5 colony forming units of a urinary tract pathogen per milliliter of urine from a MSU specimen on a single occasion (probable ASB) or on consecutive occasions (confirmed ASB). Results:Of the 266 urines collected, 234 were sterile and 29 had significant bacteriuria yielding a prevalence of probable ASB of 10.9% (29/266). Fourteen patients had confirmed ASB (prevalence 5.3%) of which 13 had pyuria. Controlling for genotype, females were 14.7 times more likely to have confirmed ASB compared to males (95%CI 1.8 to 121.0). The number of recorded visits for symptomatic UTI was increased by a factor of 2.5 (95% CI 1.4 to 4.5, p < 0.005) but serum creatinine, uric acid and haematology values were not different in patients with confirmed ASB compared with those with sterile urine. There was no association with history of gram negative sepsis. Conclusion:ASB is a significant problem in individuals with SCD and may be the source of pathogens in UTI. However, further research is needed to determine the clinical significance of ASB in SCD.

Significant bacteriuria in children with sickle cell anaemia in a Nigerian tertiary hospital

“…The lower prevalence of significant bacteriuria obtained in our study could be due to the fact that most of our study population were SCA subjects in steady state, while Zaria 8 , Maiduguri 9 and Ibadan 12 studies were febrile children with SCA. Differences in the methodology may have contributed to the lower prevalence observed in our study as compared to studies by Akinbami et al 11 and Cumming et al 10 Whilst our study used clean-catch, mid -stream and supra pubic aspiration urine specimen, Cumming and Akinbami et al 11 used only clean catch, midstream urine sample for their study. Supra pubic aspiration is more aseptic technique with reduced contamination rate.…”

Asymptomatic bacteriuria among HIV positive pregnant women

“…It is not, therefore, surprising the high prevalence found in this study. 6,14,19,20 The present study demonstrated a significant and independent association between the presence of ASB and both CD4 counts and viral load. These results imply that the more morbid the patients the higher the risk of asymptomatic bacteriuria and, possibly, the more vulnerability to bacterial and other opportunistic infections.…”

“…However, the result is similar to those seen in patients with other immune suppressive clinical conditions like diabetes mellitus and sickle cell disease. 19,20 The risk factors for ASB in this patients were low CD4 counts and high viral load.…”

Abdominal Pain in Children With Sickle Cell Disease

“…22 There is also an association between symptomatic UTI and sickle cell pain episodes, bacteremia, and pneumonia. 25 Consideration for UTI should be taken when a child with SCD presents with abdominal pain. Diagnosis is completed by obtaining a clean catch urinalysis with a reflex culture, which is a relatively simple and inexpensive test, followed by treatment with the appropriate antibiotic.…”