Bacteria urinary tract infection in HIV-infected children and adolescents in Abuja, Nigeria: a cross-sectional study

Abstract

Background: Urinary tract infection (UTI) remains the second commonest opportunistic infections among HIV infected children. This study was conducted to determine the prevalence and causative bacteria of UTI in HIV infected children and adolescents on antiretroviral medications in our health institution.

Method: The study was a cross sectional design conducted between October 2017 and March 2018 among HIV infected children and adolescents aged 2 months to 18 years on follow up attendance at the Paediatric Outpatient Special Treatment Clinic (POSTC) of University of Abuja Teaching Hospital (UATH). Early morning midstream urine was collected from each participant for urinalysis, microscopy and aerobic bacterial culture. Bacteria were identified from culture by standard microbiological methods and antibiogram of the isolates was determined by the disk diffusion method.

Result: Of 166 HIV infected children and adolescents studied, 106 (63.9%) were males, 82 (49.4%) were in age group 5-10 years, and 110 (66.3%) were from lower socio-economic class. Significant bacteria (UTI) were isolated in 54 (32.5%) subjects, with 38 (70.4%) from females, and 51 (94.4%) from those on first line antiretroviral therapy. Isolates recovered were Escherichia coli 20 (37.0%), Klebsiella pneumoniae 16 (29.6%), Staphylococcus aureus 8 (14.8%), Pseudomonas aeruginosa 6 (11.1%), and Proteus mirabilis 4 (7.4%). Leucocyturia in 19 (35.2%), nitrituria in 10 (18.5%), and haematuria in 15 (27.8%) subjects with significant bacteriuria were also recorded. Isolates were sensitive to ofloxacin (81.5%), nalidixic acid (74.1%) and cefuroxime (61.1%), while they were resistant to cotrimoxazole (100%), ampicillin (98.1%) and piperacillin (94.4%). Significant difference was observed in the mean CD4 cell count and viral load of subjects with significant bacteriuria compared to those without; 838.6 ± 177.8 versus 1009.9 ± 234.7 cells/μL (p=0.02), and 10, 360.5 ± 471.0 versus 5, 840.8 ± 563.8 copies/ml (p=0.003) for CD4 cell count and viral load respectively.

Conclusion: This study reported a high prevalence of UTI among HIV infected children and adolescents, especially in those with high viral load. Routine screening for UTI should be offered to HIV infected children and adolescents with high viral load.

Keywords: HIV, urinary tract infection, children, adolescents