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Screening for urinary tract infection in children with cancer
S T Munyi1, W M Macharia, A J Alwar
1Kenyatta National Hospital, Alwar, Nairobi.
Insights
Urinary tract infections (UTI) are common in children undergoing cancer treatment. Screening for pyuria is a reliable and cost-effective method for diagnosing UTI in these vulnerable patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Clinical Microbiology
Background:
- Children with malignancies, particularly leukemia and lymphoma, face increased infection risks due to neutropenia and immunosuppression.
- Urinary tract infections (UTIs) are a significant concern in this population, potentially complicating cancer treatment.
- Limited laboratory resources in many regions necessitate evaluation of accessible diagnostic methods.
Purpose of the Study:
- To determine the prevalence of UTI in children undergoing cancer treatment at Kenyatta National Hospital.
- To evaluate the accuracy of simple, inexpensive screening methods for UTI against a gold standard urine culture.
- To assess the utility of pyuria and nitrite tests as diagnostic tools in resource-limited settings.
Main Methods:
- A cross-sectional study enrolled 186 children aged 5-14 years with leukemia or lymphoma.
- Clinical evaluation, urinalysis (including pyuria and nitrite tests), and urine culture and sensitivity were performed.
- Urine culture served as the gold standard for UTI diagnosis.
Main Results:
- The prevalence of UTI was 8.1% (CI = 6.1, 10.1), with most cases asymptomatic.
- Escherichia coli and Klebsiella spp. were the predominant pathogens (93.4%).
- Pyuria demonstrated high sensitivity (80.0%) and specificity (97.1%), while the nitrite test showed 60% sensitivity and 97.7% specificity.
Conclusions:
- UTI is a frequent complication in pediatric cancer patients.
- Screening for pyuria is a simple, inexpensive, and accurate method for UTI diagnosis in resource-limited settings.
- Pyuria screening aids in timely UTI diagnosis and management for children with lymphohaematopoietic malignancies.
Abstract:
Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.