Screening of asymptomatic bacteriuria in children with sickle cell disease

Background Asymptomatic bacteriuria (ASB) refers to two consecutive urine cultures growing more than 100 000 CFU/ml in a patient with no symptoms of urinary tract infection. In patients with sickle cell disease (SCD), the anatomical and physiological defects make ASB more prone to worsen the sickle nephropathy. Early detection and management of ASB in children with SCD may retard this progression. Aim To investigate the prevalence of ASB, its major determinants, and its effect on kidney functions in patients with SCD for early detection and treatment. Patients and methods The study was conducted at a children's hospital during the period between June 2019 and February 2020. The study included 30 children previously diagnosed as having SCD. Midstream urine samples were collected twice from all patients and subjected to urinalysis and culture on chromogenic media. Only significant isolates were identified and subjected to antimicrobial susceptibility testing. Patients were divided into either ASB or sterile urine group. All patients with SCD were subjected to complete blood picture, reticulocytic count, markers of hemolysis, and serum creatinine.Results The prevalence of confirmed ASB was 16.7%. All children in ASB group had pyuria (100%). Staphylococcus saprophyticus (60%) was the commonest organism isolated, followed by Escherichia coli (20%) and Klebsiella pneumoniae (20%). Sulfamethoxazole+trimethoprim was the most sensitive antibiotic among all isolated microorganisms. The differences in kidney function results between the two groups were statistically insignificant.Conclusion ASB was of high prevalence in pediatric patients with SCD in Egypt at our hospital. Pyuria was the only major determinant. S. saprophyticus was the predominant organism. Serum creatinine was a nonsensitive marker to monitor kidney functions.