Prevalence of Asymptomatic Bacteriuria in HIV Infected Patients in a Tertiary Hospital in Lagos, Nigeria

Akinsegun Akinbami, Ibidun Bode-Shojobi, Sarah Ajibola, Olajumoke Oshinaike, Adewumi Adediran, Olaitan Ojelabi, Kamal Ismail, Bodunrin Osikomaiya

Department of Haematology and Blood Transfusion, College of Medicine, Lagos State University, Ikeja, Nigeria.
Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of La- gos, Lagos, Nigeria.
Department of Haematology and Blood Transfusion, Lagos State University, Teaching Hospital, Ikeja, Nigeria.
Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idiaraba, Nigeria.
Department of Medical Microbiology, Lagos University Teaching Hospital, Idiaraba, Nigeria.
Department of Medicine, College of Medicine, Lagos State University, Ikeja, Nigeria.

DOI: 10.4236/wja.2013.32014                

Abstract

Background: People living with Human Immunodeficiency Virus (HIV) are more predisposed to urinary tract infections due to suppression of their immunity by the virus. Asymptomatic bacteriuria is associated with an increased risk of symptomatic urinary tract infection and the latter being an important contributor to development of chronic renal failure, hypertension and toxaemia of pregnancy. The aim of this study was to determine the prevalence of asymptomatic bacteriuria in HIV-infected patients and proffer a recommendation on the need or otherwise to screen. Methods: This was a cross sectional study of treatment-naive HIV-infected patients attending the HIV clinics of Lagos State University Teaching Hospital (LASUTH), Ikeja. A single voided aseptically collected mid-stream urine (MSU) was obtained from each patient and all samples processed immediately, were sent for urinalysis and culture. Isolates were considered significant if there were ≥10⁵ colony forming unit/mL (CFU/mL) with 2 or less isolates, doubtful significance if <10⁵ CFU/mL. Significant isolates were selected for identification. Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). Results: A total of 156 consenting participants were recruited into the study. The mean age was 36.45 ± 8.65 years. There were 60 of 156 (38.4%) males and 96 of 156 (61.56%) females. Only 33 of 156 (21.2%) had significant bacteriuria, out of the 33 participants, 19 (57.8%) were asymptomatic, while 14 of 33 (42.4%) had significant growth but were symptomatic or on antibiotics. E. coli was isolated in 9 of 19 (47.3%), followed by Staph aureus 4 of 19 (21.05%). Conclusion: More than half of participants who had significant growth had asymptomatic bacteriuria, while one-fifth of all patients had significant growth. Considering this statistics, screening for or treatment of asymptomatic bacteriuria may be recommended in all HIV-infected patients.

Keywords

Prevalence; Screening; Asymptomatic Bacteriuria; HIV-Infected Patients

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. H. Rubin, E. D. Shapiro, V. T. Andriole, R. J. Davis and W. E. Stamm, “Evaluation of New Anti-Infective Drugs for the Treatment of Urinary Tract Infection,” Clinical Infectious Diseases, Vol. 15, Suppl. 1, 1992, pp. S216-S227. doi:10.1093/clind/15.Supplement_1.S216
[2]	R. Colgan, “Asymptomatic Bacteriuria in Adults,” American Family Physician, Vol. 74, No. 6, 2006, pp. 985-999.
[3]	L. E. Nicolle, S. Bradley and R. Colgan, “Infectious Disease Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults,” Clinical Infectious Diseases, Vol. 40, No. 5, 2005, pp. 643-654. doi:10.1086/427507
[4]	J. Sobel and D. Kaye, “Urinary Tract Infections. Principle and Practice of Infectious Disease,” 6th Edition, Elsvier Churchhill Livingstone, Philadelphia, 2005.
[5]	C. M. Kunin and J. E. De Groot, “Self-Screening for Significant Bacteriuria. Evaluation of Dip-Strip Combination Nitrite/Culture Test,” The Journal of American Medical Association, Vol. 231, No. 13, 1975, pp. 1349-1353.
[6]	R. D. Mc Nair, “Evaluation of the Centrifugal and GramStain Smear, Urinalysis and Reagent Strip Testing to Detect Asymptomatic Bacteriuria in Obstetric Patients,” American Journal of Obstetrics and Gynaecology, Vol. 182, No. 5, 2000, pp. 1076-1079.
[7]	E. N. Lindsay, “Asymptomatic Bacteriuria When to Screen and When to Treat,” Infectious Disease Clinics of North America, Vol. 17, No. 2, 2003, pp. 367-394.
[8]	C. W. Norden and E. H. Kass, “Bacteriuria of Pregnancy—A Critical Appraisal,” Annual Review of Medicine, Vol. 19, 1968, pp. 431-470. doi:10.1146/annurev.me.19.020168.002243
[9]	J. R. Johnson, P. L. Roberts and W. E. Stamm, “P Fimbriae and Other Virulence Factors in Escherichia coli Urosepsis: Association with Patients’ Characteristics,” Journal of Infectious Diseases, Vol. 156, No. 1, 1987, pp. 225-229.
[10]	A. I. M. Hoepelman, M. Van Buren and P. J. Van den Broek, “Bacteriuria in Men Infected with HIV-1 Is Related to Their Immune Status (CD4+ Cell Count),” AIDS, Vol. 6, No. 2, 1992, pp. 179-184.
[11]	“US Preventive Services Task Force Guide to Clinical Preventive Services,” 2nd Edition, Screening for Asymptomatic Bacteriuria, 1996. http://www.ahcpr.gov/clinic/uspstfix.htm
[12]	J. K. Kayima, L. S. Otieno, A. Twahir and E. Njenga, “Asymptomatic Bacteriuria among Diabetics Attending Kenyatta National Hospital,” East African Medical Journal, Vol. 73, No. 8, 1996, pp. 524-526.
[13]	Y. Kumamoto, T. Tsukamoto, M. Ogihara, K. Ishibashi, T. Hirose, et al., “Comparative Studies on Activities of Antimicrobial Agents against Causative Organisms Isolated from Patients with Urinary Tract Infections (2000). I. Susceptibility Distribution,” Japanese Journal of Antibiotics, Vol. 57, 2002, pp. 246-274.
[14]	P. C. Inyang-Etoh, G. C. Udofia, A. A. A. Alaribe and N. E. Udonwa, “Asymptomatic Bacteriuria in Patients on Antiretroviral Drug Therapy in Calabar,” Journal of Medical Sciences, Vol. 9, No. 6, 2009, pp. 270-275. doi:10.3923/jms.2009.270.275
[15]	T. P. Flanigan, J. W. Hogan and D. Smith, “Self-Reported Bacterial Infections among Women with or at Risk for Human Immunodeficiency Virus Infection,” Clinical Infectious Diseases, Vol. 29, No. 3, 1999, pp. 608-612. doi:10.1086/598641
[16]	J. K. Evans, A. McOwen, R. J. Hilman and G. E. Foster, “Incidence of Symptomatic Urinary Tract Infections in HIV Seropositive Patients and Use of Cotrimoxasole as Prophylaxis against Pneumocystics Carina Pneumonia,” Genitourinary Medicine, Vol. 71, No. 2, 1995, pp. 120-122.
[17]	D. Scholes, T. M. Hooton and D. L. Roberts, “Risk Factors for Recurrent Urinary Tract Infection in Young Women,” Journal of Infectious Diseases, Vol. 182, No. 4, 2000, pp. 1177-1182. doi:10.1086/315827
[18]	B. Foxman and R. R. Frerichs, “Epidemiology of Urinary Tract Infection 1. Diaphragm Use and Sexual Intercourse,” American Journal of Public Health, Vol. 75, No. 11, 1985, pp. 1314-1317. doi:10.2105/AJPH.75.11.1314
[19]	P. Catherine and N. Marie-Louise, “Asymptomatic Bacteriuria, Important or Not?” The New England Journal of Medicine, Vol. 343, No. 14, 2000, pp. 1037-1039.
[20]	T. M. Hooton, D. Scholees, A. E. Stapleton, P. L. Roberts, C. Winter and K. Gupta, “A Prospective Study of Asymptomatic Bacteriuria in Sexually Active Young Women,” New England Journal of Medicine, Vol. 343, 2000, pp. 991-997. doi:10.1056/NEJM200010053431402
[21]	J. W. Bachman, R. H. Heise, J. M. Naessons and M. G. Timmerman, “A Study of Various Tests to Detect Asymptomatic Urinary Tract Infections in an Obstetric Population,” JAMA, Vol. 270, No. 16, 1993, pp. 1971-1974. doi:10.1001/jama.1993.03510160089035
[22]	G. G. Zhanel, L. E. Nicolle and G. M. Harding, “Manitoba Diabetic Urinary Infection Study Group. Prevalence of Asymptomatic Bacteriuria and Associated Host Factors in Women with Diabetes Mellitus,” Clinical Infectious Diseases, Vol. 21, No. 2, 1995, pp. 316-322. doi:10.1093/clinids/21.2.316
[23]	A. Chaudhry, W. J. Stone and J. A. Breyer, “Occurence of Pyuria and Bacteriuria in Asymptomatic Haemodialysis Patients,” American Journal of Kidney Diseases, Vol. 21, No. 2, 1993, pp. 180-183.
[24]	S. K. Gupta, B. W. Mamlin and C. S. Johnson, “Prevalence of Proteinuria and the Development of Chronic Kidney Disease in HIV-Infected,” Clinical Nephrology, Vol. 61, No. 1, 2004, pp. 1-6.
[25]	J. Jao, D. Palmer and I. Leus, “Prevalence and Predictors of Proteinuria in HIV-Infected and Uninfected Pregnant Women in Cameroun,” Nephrology Dialysis Transplantation, Vol. 26, No. 9, 2011, p. 3051.
[26]	J. Ojoo, J. Paul, B. Batchelor, M. Amir, J. Kimari and C. Mwachari, “Bacteriuria in a Cohort of Predominantly HIV1 Seropositive Female Commercial Sex Workers in Nairobi,” Journal of Infection, Vol. 33, No. 1, 1996, pp. 33-37. doi:10.1016/S0163-4453(96)92719-X
[27]	A. M. De Pinto, G. S. Lopes, C. F. Ramos-Filho, R. Santos-Oda, M. P. De Oliveira, M. Halpern, et al., “Urinary Tract Infection in Men with AIDS,” Genitourinary Medicine, Vol. 70, No. 1, 1994, pp. 30-34.
[28]	O. M. Ibadin, A. Onunu and G. M. Ukoh, “Urinary Tract Infection in Adolescent/Young Adult Nigerians with Acquired Human Immuno Deficiency Disease in Benin City,” Journal of Medicine and Biomedical Research, Vol. 5, No. 2, 2006, pp. 55-60.
[29]	C. J. Bennett, M. N. Young and H. Darrington, “Difference in Urinary Tract Infections in Male and Female Spinal Cord Injury Patients on Intermittent Catheterization,” Paraplegia, Vol. 33, 1995, pp. 69-72. doi:10.1038/sc.1995.17
[30]	L. E. Nicolle, J. Bjornson, G. K. Harding and J. A. MacDonell, “Bacteriuria in Elderly Institutionalized Men,” New England Journal of Medicine, Vol. 309, 1983, pp. 1420-1425. doi:10.1056/NEJM1 98312083092304
[31]	L. E. Nicolle, W. J. Mayhew and L. Bryan, “Prospective, Randomized Comparison of Therapy and No Therapy for Asymptomatic Bacteriuria in Institutionalized Elderly Women,” American Journal of Medicine, Vol. 83, No. 1, 1987, pp. 27-33. doi:10.1016/0002-9343(87)90493-1
[32]	C. M. Kunin, R. Deutscher and A. Paquin, “Urinary Tract Infection in School Children: An Epidemiologic, Clinical and Laboratory Study,” Medicine (Baltimore), Vol. 43, 1964, pp. 91-130.
[33]	A. L. Le Blanc and W. J. McGanity, “The Impact of Bacteriuria in Pregnancy—A Survey of 1300 Pregnant Patients,” Biology and Medicine Journal (Paris), Vol. 22, 1964, pp. 336-347.
[34]	G. G. Zhanel, L. E. Nicolle and G. M. Harding (Manitoba Diabetic Urinary Infection Study Group), “Prevalence of Asymptomatic Bacteriuria and Associated Host Factors in Women with Diabetes Mellitus,” Clinical Infectious Diseases, Vol. 21, No. 2, 1995, pp. 316-322. doi:10.1093/clinids/21.2.316
[35]	L. E. Nicolle, “Asymptomatic Bacteriuria in the Elderly,” Infectious Disease Clinics of North America, Vol. 11, No. 3, 1997, pp. 647-662. doi:10.1016/S0891-5520(05)70378-0
[36]	J. O. Ehinmidu, “Antibiotics Susceptibility Patterns of Urine Bacterial Isolates in Zaria, Nigeria,” Tropical Journal of Pharmaceutical Research, Vol. 2, No. 2, 2003, pp. 223-228.
[37]	O. Akinloye, D. O. Ogbolu, O. M. Akinloye and O. A. Terry Alli, “Asymptomatic Bacteriuria of Pregnancy in Ibadan, Nigeria: A Re-Assessment,” British Journal of Biomedical Science, Vol. 63, No. 3, 2006, pp. 109-112.