Urinary tract infection (UTI) in children is a complex issue which attributes to childhood morbidity in the developing world, particularly in Africa. In a review article published recently in the Italian Journal of Pediatrics, Chukwu et al. evaluate the prevalence of asymptomatic bacteriuria in children with homozygous sickle hemoglobin at a teaching hospital in Enugu, Nigeria. Whilst their work indicates an increase of bacteria present in urine samples of children (aged 2-12 years) with sickle cell anemia when compared to children with normal hemoglobin, a larger scale study would definitively support these results and have implications for UTI screening.
In the article the authors describe the representation of bacterial organisms found in the urinary tract of children. They compare the range of pathogens in children from developed countries, where Escherichia coli represents 80-90% of these organisms, to those in less developed countries – where causative organisms such as Staphylococcus aureus, Streptococcus faecalis and proteus species are present in much larger proportions in the urinary tract.
An additional concern raised from the study were the results from the sensitivity tests of these organisms, which presented high resistance to first-line older antibiotics such as cotrimoxazole, ampicillin, streptomycin and tetracycline (as noticed in children over 8 years). Whilst there could be any number of reasons or contributing factors to the high level of resistance to these antibiotics, the authors suggest it could be a mix of drug resistance developed by the pathogens, low patient compliance, self-medication and potentially sub-therapeutic prescription by health workers. Whilst the review provides us with an interesting insight into childhood UTIs, clearly further studies are necessary to resolve various related issues related, from screening to treatment methods.