The prevalence and risk of urinary tract infection in malnourished children: a systematic review and meta-analysis

Abstract

Background There are vast differences in prevalence rates of urinary tract infection (UTI) reported among malnourished children globally. We conducted a systematic review and meta-analysis to provide estimates of pooled prevalence of UTI among these children and combined UTI risk in comparison with their well-nourished counterparts. Methods We systematically searched electronic databases (MEDLINE, EMBASE, ISI Web of Science and African Journals Online; date of the last search: 22 December 2018) for studies reporting either the prevalence of UTI in malnourished children or parallel healthy controls. Eligible primary studies were observational studies of children in English Language reporting UTI prevalence with background malnutrition or with enough data to compute these estimates, as well as studies which reported at the same time UTI prevalence in healthy controls. We synthesized published prevalence rates or associations (odds ratios [OR]) between malnutrition and UTI and their 95% confidence intervals (CI) using random effects meta-regression and explored potential heterogeneity determinants using meta-regression analysis. This review is registered with PROSPERO, number- CRD42018084765. Results We included 26 cross-sectional and 8 case-control studies reporting on UTI prevalence in malnourished children, and in malnourished children vs. healthy controls, respectively. The pooled prevalence of UTI in 3294 malnourished children was 17% (95% CI, 13, 21%). Heterogeneity was high (I 2 = 87.6%; Tau 2 = 0.06) as studies varied in their sample size, degree of malnutrition, and study period. Multivariate meta-regression model, including these factors, explained 34.6% of the between-study variance. Pooled OR of UTI in association with malnutrition in 2051 children (1052 malnourished children vs. 999 controls) was 2.34 (95% CI, 1.15, 3.34), with lower between-study heterogeneity (I 2 = 53.6%; Tau 2 = 0.47). Conclusions UTI is more prevalent in malnourished children than in their well-nourished counterparts. Screening and treatment for UTI should be incorporated in the management protocol of malnourished children to improve disease outcomes. Electronic supplementary material The online version of this article (10.1186/s12887-019-1628-y) contains supplementary material, which is available to authorized users.

Impact of Heat-Killed Lactobacillus casei Strain IMAU60214 on the Immune Function of Macrophages in Malnourished Children

“…Approximately 25% of children younger than 5 years of age show a malnourished state in developing countries [ 2 ]. Malnutrition remains an important risk factor for predisposition to respiratory and intestinal infections [ 3 , 4 , 5 , 6 ]. Protein energy malnutrition (PEM) is also an immunodeficiency that is strongly associated with susceptibility to infections [ 7 , 8 ].…”

Etiological characteristic and risk factors of ESBL-Urinary Tract Infections: A nomogram had been built and Urologist should act in time

“…tethered cord syndrome, meningitis, hypoxic ischemic encephalopathy, invisible spina bi da) and urodynamic change were risk factors for ESBL-UTI is still unknown. Studies also reported that the prevalence of UTI and ESBL (+) UTI was higher in malnourished children [13,14] . Whether undernourishment was independent risk factors for ESBL positive UTI is also unclear.…”

“…In a systematic review and meta-analysis, 26 cross-sectional and 8 case-control studies reporting on UTI prevalence in malnourished children was included, and they found that UTI is more prevalent in malnourished children than in their well-nourished counterparts [13] . Another study included 402 malnourished children in Tanzania and data showed that more than 37 % of UTI isolates were exhibiting extended spectrum beta lactamase (ESBL) phenotype [14] .…”

Impact of early-life weight status on urinary tract infections in children: a nationwide population-based study in Korea

“…The risk of UTIs was U-shaped in certain age groups, suggesting that both underweight and obesity predispose children to UTIs. In a recent meta-analysis involving 3,294 malnourished children, the pooled odds ratio for UTIs was 2.34 with respect to malnutrition, and the risk of UTIs increased with the severity of malnutrition [ 14 ]. In a systematic review of children aged 6-59 months, UTIs were found in 24.1% of severely malnourished children [ 21 ].…”

“…The worldwide prevalence of childhood obesity has been increasing, and that of childhood underweight still remains high [ 12 , 13 ]. Although associations between the weight status of children and UTI prevalence have been documented in the severely underweight or obese individual category [ 5 , 14 , 15 ], to the best of our knowledge, no comparable analysis has yet explored the associations of UTI incidence with a comprehensive set of BMI categories, ranging from underweight to obese, among children. Population-based epidemiology studies regarding UTIs in children are also unavailable in Korea, although a few retrospective population-based studies have been published based on epidemiological data on UTIs in other countries [ 16 , 17 ].…”