Screening of Asymptomatic Bacteriuria in Sickle Cell Pediatric Patients

Abstract

Abstract Background Asymptomatic bacteriuria (ASB) refers to two consecutive urine cultures growing more than 100,000 colony forming units (CFU)/ml of a bacterial species in a patient with no symptoms of urinary tract infection (UTI). In sickle cell disease (SCD) patients, the anatomical and physiological defects associated with the disease make ASB more prone to worsen the sickle nephropathy and cause more kidney damage. Also, the urine concentration and acidification defects associated with SCD enhance urinary bacterial formation and proliferation. In resource poor settings where renal replacement therapy is limited, early detection and management of ASB in SCD children may retard this progression. Aim of the Work The current study aims to investigate the prevalence of asymptomatic bacteriuria, its major determinants and its effect on kidney functions in SCD patients for early detection and treatment. Patients and Methods The study was conducted at Ain Shams University Children's Hospital and the Main Microbiology Laboratory at Clinical Pathology Department during the period between June 2019 and February 2020.The study included 30 children previously diagnosed as SCD by HB electrophoresis. A fresh voided mid-stream urine samples were collected once from all patients and subjected to urinalysis and culture on chromogenic media. Patients with positive culture results were asked to get another sample to confirm their culture results, while those with contaminated results were re-Instructed with precautions to get another fresh voided mid-stream urine samples. Only significant isolates were identified and subjected to antimicrobial susceptibility testing using disk diffusion method according to CLSI 2017. Patients were divided either into ASB or sterile urine groups according to their culture results. All SCD Patients were subjected to complete blood picture (CBC), reticulocytic count, markers of haemolysis (total, indirect bilirubin and LDH) and serum creatinine. Results The prevalence of confirmed ASB was 16.7% (5/30).All children in ASB group had pyuria(100%). Staph.saprophyticus (60%) (3/5)was the commonest organism isolated from the urine of these patients, followed by E.coli (20%)(1/5) & Klebsiella pnuemoniae (20%)(1/5).Sulfamethoxazole +Trimethoprim (Sutrim) was the most sensitive antibiotic among all isolated microorganisms.The difference in kidney funtion results among the two groups were statistically insignificant. Conclusion Asymptomatic bacteriuria was of high prevalence in SCD pediatric patients in Egypt at Ain Shams University Hospitals. Pyuria was the only major determinant of ASB in this study.Staph.saprophyticus was the predominant organism isolated from ASB group. Sulfamethoxazole +Trimethoprim (Sutrim) was the drug of choice for empirical treatment of UTI. Serum creatinine was a non-sensitive marker to monitor any minor impairment in kidney functions.