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Abstract
BackgroundIt 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.MethodsThis 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 ≥ 105 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).ResultsOf 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.ConclusionASB 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.
Highlights
It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD)
The definition of asymptomatic bacteriuria (ASB) is controversial as some have defined it as the quantitative growth of bacteria, greater than or equal to 105 colony forming units per milliliter urine of the same organism, on aseptically collected midstream urine specimens, in the absence of symptoms of urinary tract infection on two or more consecutive occasions [1,2] while for others a single occasion is sufficient [3,4,5]
The prevalence of probable ASB and confirmed ASB were determined as the ratio of the number of urines classified as probable ASB and confirmed ASB, to the total number of collected midstream urine (MSU) samples
Summary
It is known that there is significant morbidity associated with urinary tract infection and with renal dysfunction in sickle cell disease (SCD). It is not known if there are potential adverse outcomes associated with asymptomatic bacteriuria (ASB) infections in sickle cell disease if left untreated. Whether ASB is a prelude to more serious renal disease and dysfunction in SCD is unclear. This present study was undertaken to estimate the prevalence and possible risk factors of ASB in the Jamaican sickle cell cohort
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