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Bacteriuria and urinary tract infections in malnourished children
Arvind Bagga1, Partha Tripathi, Vishal Jatana
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. arvindbagga@hotmail.com
Insights
Malnourished children, especially those with fever or diarrhea, have a higher risk of developing urinary tract infections (UTI). Early urinalysis and urine culture are recommended for early detection and treatment of UTI in this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Malnutrition is a significant global health issue in children.
- Urinary tract infections (UTIs) can be serious, especially in vulnerable populations.
- The relationship between malnutrition and UTI incidence requires further investigation.
Purpose of the Study:
- To determine the incidence of bacteriuria in malnourished children aged 6 months to 5 years.
- To compare bacteriuria rates between malnourished children and age/sex-matched controls.
- To identify risk factors associated with bacteriuria in malnourished children.
Main Methods:
- Prospective study comparing 112 malnourished children with matched controls.
- Urine specimens collected via clean-catch and suprapubic aspiration.
- Microscopic examination and culture of urine samples to detect bacteriuria.
Main Results:
- Significantly higher incidence of bacteriuria in malnourished children (15.2%) compared to controls (1.8%) (P<0.01).
- Increased risk of bacteriuria with severe malnutrition, fever, and diarrhea.
- Bacteriuria was symptomatic and associated with elevated acute-phase reactants, suggesting infection over colonization.
Conclusions:
- Malnourished children are at increased risk for UTIs, particularly those with fever.
- Urinalysis is a valuable screening tool for UTI in malnourished children.
- Urine culture is recommended for patients with abnormal urinalysis or high likelihood of bacteriuria; prompt antimicrobial treatment is advised.
Abstract:
We prospectively examined the incidence of bacteriuria in malnourished patients between 6 months and 5 years of age. For each patient, a normally nourished control matched for age, sex, and presence of fever and diarrhea was included. Of 112 patients (65 boys), 55 had moderate and 57 had severe malnutrition; 43 had diarrhea and 35 had fever. Clean-catch and suprapubic urine specimens were examined microscopically and cultured. Significant bacteriuria was found in 17 (15.2%) malnourished and 2 (1.8%) control subjects ( P<0.01). The incidence of bacteriuria in malnourished and normally nourished subjects with fever was 28.6% and 5.7%, respectively ( P<0.05). The risk of bacteriuria increased significantly with the severity of malnutrition and in patients with diarrhea. Bacteriuria was associated with symptoms (70.6%) and elevated levels of acute-phase reactants (88.2%), indicating the presence of urinary tract infections (UTI) rather than asymptomatic colonization. Our observations show that malnourished children, particularly those with fever, are at risk for UTI. Urinalysis is useful for screening for UTI in these subjects. Urine culture should be performed in patients showing an abnormal urinalysis, and if the likelihood of detecting bacteriuria is high (as in patients with fever or diarrhea). Significant bacteriuria in malnourished subjects should be treated with appropriate antimicrobials.