Prevalence of asymptomatic bacteriuria in school children in Khartoum State, Sudan

Abstract

Background: prevalence of asymptomatic bacteriuria (ABU) in school children is variable worldwide
and treatment and screening are controversial. Our aim was to determine the prevalence of ABU in school
children in Khartoum State.
Materials & Methods: this was a cluster randomized survey among school children aged 5-16 years from
randomly selected basic schools in Arkaweet Area in Khartoum State. Midstream urine samples in sterile
containers were sent to the laboratory within ½-1 hour where they were tested by nitrites (N) and leukocyte
esterase (LE) dipsticks and cultured on Cystine Lactose Electrolyte Deficient (CLED) agar. Antibiotic
sensitivity discs were then added. After evaluating colony count, organisms were identified by biochemical
tests.
Results: Three handred fourty five school children: girls 58% and boys 42%, were enrolled in the study.
The overall prevalence of ABU was 2.6%. The prevalence was 3.5% for girls and 1.6% for boys. Isolated
organisms were Cedecea davisae (33.3%), Staphylococcus aureus (22.2%), Escherichia coli (E. coli),
Citrobacter, Proteus mirabilis, Providencia rettgeri (11.1%) each. Sensitivity of LE and N dipsticks was
22.2% & 11.1% respectively, whereas specificity was 98.8% & 99.9% respectively. The positive predictive
value (PPV) for LE and N tests was 33.3% & 25% respectively ,whereas the negative PV(NPV) was 97.9%
& 97.7% respectively. When using both LE and N, the positive PV was 50% whereas the specificity and
the negative PV was 99.9% and 99.7% respectively. ABU was not significantly associated with any of the
potential risk factor (P>00.5 for all).
Conclusion: the prevalence of ABU in school children in Khartoum State is low, but higher than in other
countries. Urine dipsticks can rule out urinary tract infection (UTI) if both N and LE tests are negative.
However, urine culture is mandatory to confirm diagnosis in positive dipsticks samples.