|Year : 2002 | Volume
| Issue : 1 | Page : 29--32
Asymptomatic bacteriuria in school going children
C SV Kumar, A Jairam, S Chetan, P Sudesh, I Kapur, Srikaramallya
Department of Microbiology, Kasturba Medical College, Mangalore - 575 001, Karnataka, India
C SV Kumar
Department of Microbiology, Kasturba Medical College, Mangalore - 575 001, Karnataka
PURPOSE: The present study was undertaken to determine the prevalence of asymptomatic bacteriuria in school going children of different age groups and sex and to isolate the organisms responsible for asymptomatic bacteriuria and to know their antimicrobial susceptibility pattern. METHODS: A total of 1817 school children were screened by collecting mid-stream urine and isolating the organisms. RESULTS: Asymptomatic bacteriuria was observed in 192 cases (10.57%) with female preponderance over male. The maximum isolates were E.coli (32.8%). Followed by Klebsiella pneumoniae (22.4%) and Staphylococcus aureus (15.1%). CONCLUSIONS: In the present study there was a steady increase in the incidence of asymptomatic bacteriuria in different age groups. Most of the isolates were resistant to one or more antibiotics.
|How to cite this article:|
Kumar C S, Jairam A, Chetan S, Sudesh P, Kapur I, Srikaramallya. Asymptomatic bacteriuria in school going children.Indian J Med Microbiol 2002;20:29-32
|How to cite this URL:|
Kumar C S, Jairam A, Chetan S, Sudesh P, Kapur I, Srikaramallya. Asymptomatic bacteriuria in school going children. Indian J Med Microbiol [serial online] 2002 [cited 2013 May 19 ];20:29-32
Available from: http://www.ijmm.org/text.asp?2002/20/1/29/8335
Asymptomatic bacteriuria, the presence of significant number of bacteria in the urine of asymptomatic patient, has been the subject of several long term studies in the school aged children.1-3 Many patients with asymptomatic bacteriuria will have symptoms of urinary tract infection when questioned closely, many will have intermittent episodes of symptomatic bacteriuria. Screening for asymptomatic bacteriuria was undertaken with the belief that early detection of infection and identification of structural abnormalities coupled with appropriate management might lead to prevention of pyelonephritis and renal damage. It is not known how frequently these infections lead to kidney damage or whether their eradication can prevent kidney damage. To prove whether it would be possible to prevent kidney damage by controlling infection, it would be necessary to screen the school children of a particular age group. This would be a tedious task unless a simple and economic screening procedure would be used which would be acceptable to the children, parents, school health authorities and bacteriologist.
Several well conducted clinical studies on asymptomatic bacteriuria in school going girls,2-4 have reported the prevalence of significant bacteriuria in school girls is approximately 2% and about 5% of girls have significant bacteriuria at some time before leaving high school. The present study was done to determine the incidence of asymptomatic bacteriuria in school children, to study the prevalence of asymptomatic bacteriuria in different age groups and variation in boys and girls, to isolate the organisms responsible for asymptomatic bacteriuria and to know their antimicrobial susceptibility pattern.
Material and Methods
A total of 1817 school children aged 11-15 years from different schools in Mangalore were screened during 1998-2000 for asymptomatic bacteriuria. The students who were suffering from urinary tract infection were not considered for the present study analysis. The study group comprised of 563 boys and 1354 girls. Before each school was visited, care was taken to notify the Head Masters/Mistress and other staff about the investigation to be carried. The total population available for screening was identified from the class register. As the collection of urine sample from the children was difficult, the instruction to the parents on the collection of mid-stream urine sample were typed on a paper and copies were distributed to the children along with sterile wide mouth bottles.
The mid-stream urine samples collected from all the children were transported to the laboratory with in half an hour to one hour. In the laboratory the specimens were examined microscopically for the presence of pus cells, RBC and casts.
A standard loop technique was used to place 0.01mL of urine on MacConkey agar and blood agar media. Then the plates were examined after overnight incubation to quantify the organisms present. The colony count was evaluated and organisms were identified by conventional methods and antimicrobial testing was done according to Kirby Bauer's method on all isolates.5 The following antibiotics were used: amikacin (30mg), ampicillin (10mg), cefuroxime (30mg), erythromycin (15mg), nalidixic acid (30mg), nitrofurantoin (300mg), norfloxacin (10mg) and tobramycin (30mg).
To rule out the possible contamination with the faecal matter, all positive samples in girls were rechecked by collecting the second urine sample from them.
[Figure:1] shows the distribution of school children among the various age groups and sex distribution among each age group. The age distribution was done in such a way that it included both prepubertal and postpubertal children. Out of 1817 school childen investigated for asymptomatic bacteriuria 192 (10.57%) showed symptomatic bacterial infection. Among 192 children 53(27.6%) were boys and 139 (72.4%) were girls [Figure:2]. The predominant isolates were E.coli (32.8%) followed by Klebsiella pneumoniae (22.4%), Staphylococcus aureus (15.1%), Pseudomonas aeruginosa (10.9%) and Enterococcus faecalis (6.3%) in that order [Table:1].
The difference in incidence of asymptomatic bacteriuria was noted in boys and girls. The incidence was same in all age groups (except age group12) in boys, but the striking feature was the gradual increase in the incidence of asymptomatic bacteriuria in girls from 11 years (7.5%) to 15 years (13.66%). Enterococcus faecalis and Proteus mirabilis were mainly isolated from girls and Staphylococcus saprophyticus was isolated from five postpubertal girls.
The [Table:2] reveals antibiotic sensitivity pattern of various isolates. Out of 63 E.coli isolated from asymptomatic school children, 10(15.9%) were resistant to all antibiotics, 19(30.2%) were resistant to one antibiotic and 34(53.9%) were resistant to three or more antibiotics.
Among 43 Klebsiella pneumoniae isolated 8(18.6%) were sensitive to all antibiotics, 8(18.6%) were resistant to one or two antibiotics and 27 (62.8%)were resistant to three or more antibiotics. All isolates of Pseudomonas aeruginosa and Proteus mirabilis were sensitive to one or more antibiotics.
Results show that although bacteriuria amongst school children, especially girls, rarely leads to endstage renal failure, it is not entirely benign and it cannot be ignored. It may be the first clue to the important underlying anatomical abnormalities in some patients. The girls with bacteriruia have more recurrent infection and urological abnormalities and are at high risk of developing bacteriuria during pregnancy.
A gradual increase in the incidence of asymptomatic bacteriuria was noted in girls from prepubertal age and to postpubertal age this finding is consistent with an earlier report.
Urinary tract infection can pose a major risk to a child's well being. Symptomatic and asymptomatic bacteriuria during infancy are generally characterised by a benign outcome. However, in some children episodes of renal damage have been reported. The prognosis in growing children may be graded if neonatal bacteriuria with or without symptoms occur in the presence of anatomical defects. Although a variety of pathogens have been identified as causing urinary tract infection., Enterobacteriaceae are usually the cause of initial uncomplicated lower tract infections. The incidence of urinary tract infection in otherwise healthy person rises considerably with age. The incidence of asymptomatic bacteriuria in infants younger than 23 months is 0.5% in boys, 1.8% in girls. In children of 24 to 60 months of age, it is estimated to be about 0.81% in girls and negligible in boys. In premature neonates the prevalence of asymptomatic bacteriuria is estimated to be about 3%.8 In children of 5 to 10 years of age, the prevalence is above 1% to 1.5%.10 However, our results show that the rate of urinary tract infection rises by approximately 1% with increase in age.
The organism most frequently isolated in asymptomatic bacteriuria and urinary tract infection includes species of Enterobacteriaceae especially E. coli and other gram negative bacteria.11 We recommend that bacteriuria of 105 organisms for mid-stream urine, observed on successive cultures in children and asymptomatic pregnant woman, should be considered significant bacteriuria and should be treated with antibiotics chosen on the basis of the invitro antibiotic sensitivity of the organism. However, it should be pointed out that other investigators have observed that treatment of asymptomatic bacteriuria in childhood does not prevent recurrences of infection. It is unlikely that most patients with asymptomatic bacteriuria will benefit from treatment, unless they become symptomatic or have significant structural abnormality of urinary tract. However, it has been found that girls with bacteriuria have considerably more recurrent infections and are at high risk of bacteriuria during pregnancy.
We would like to thank Principal of Canara High School-Kodialbail, Mangalore, Sri Ramakrishna School, Mangalore, New Mangalore Port Trust School, Mangalore, and Canara High School, Urva, Mangalore, for their kind co-operation.
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