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Prevalence of Asymptomatic Bacteriuria in Children: A Meta-Analysis
Nader Shaikh1, Victor A Osio1, Charles B Wessel2
1Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Insights
Asymptomatic bacteriuria in children is rare, affecting less than 0.5% of boys and girls. This low prevalence suggests current urinary tract infection (UTI) diagnostic criteria may need reevaluation for young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Asymptomatic bacteriuria (ASB) in children is a condition where bacteria are present in the urine without symptoms.
- Concerns exist regarding potential misdiagnosis of urinary tract infections (UTIs) in children with ASB presenting with febrile illnesses.
- Understanding the prevalence of ASB is crucial for accurate diagnosis and management in pediatric populations.
Purpose of the Study:
- To systematically review and determine the point prevalence of asymptomatic bacteriuria (ASB) in children.
- To determine the prevalence of ASB without pyuria (white blood cells in urine) in asymptomatic children.
- To identify subgroups of children with higher prevalence rates of ASB.
Main Methods:
- A systematic literature review was conducted using MEDLINE and EMBASE databases.
- Studies included asymptomatic children up to 19 years of age with urine samples collected via suprapubic aspiration, catheterization, or clean-catch methods.
- Data were abstracted by two independent reviewers from 14 included studies encompassing 49,806 children.
Main Results:
- The overall prevalence of asymptomatic bacteriuria was 0.37% in boys and 0.47% in girls.
- Asymptomatic bacteriuria without pyuria was found in 0.18% of boys and 0.38% of girls.
- Higher prevalence rates were observed in uncircumcised males under 1 year and females over 2 years; prevalence in males after infancy was 0.08%.
Conclusions:
- The low prevalence of asymptomatic bacteriuria in children suggests that misdiagnosis of UTI in febrile children with ASB is rare.
- Current definitions for diagnosing urinary tract infections (UTIs) in children may warrant reconsideration based on these findings.
- Further evaluation of diagnostic criteria is suggested to improve accuracy and avoid unnecessary treatment in pediatric patients.
Objective:
To determine the point prevalence of bacteriuria and bacteriuria without pyuria in asymptomatic children by a systematic review of the literature.
Study Design:
We searched MEDLINE and EMBASE for English-, French-, German-, Italian-, and Spanish-language articles. We included articles reporting data on bacteriuria in asymptomatic children up to 19 years of age who had urine collected by suprapubic bladder aspiration, bladder catheterization, or by 3 consecutive clean catch samples. Two independent reviewers assessed studies for inclusion and abstracted data.
Results:
Fourteen studies (49 806 children) were included. The prevalence of asymptomatic bacteriuria was 0.37% (95% CI, 0.09-0.82) in boys and 0.47% (95% CI, 0.36-0.59) in girls. The corresponding values for asymptomatic bacteriuria without pyuria were 0.18% (95% CI, 0.02-0.51) and 0.38% (95% CI, 0.22-0.58), respectively. The subgroups with the highest prevalence of asymptomatic bacteriuria were uncircumcised males <1 year of age and females >2 years of age. In males, the prevalence of asymptomatic bacteriuria after infancy was 0.08% (95% CI, 0.01-0.37). The median duration of asymptomatic bacteriuria in untreated boys and girls, from the one study reporting this outcome, was 1.5 and 2 months, respectively.
Conclusions:
Some clinicians are concerned that when a preverbal child with asymptomatic bacteriuria develops a nonlocalizing febrile illness and presents for evaluation, they may be mistakenly diagnosed as having a urinary tract infection (UTI). Given that the prevalence of asymptomatic bacteriuria is considerably lower than the prevalence of UTI in most subgroups examined, this will occur extremely rarely. These data suggest that the current definition of UTI should be revisited.
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