PREVALENCE OF ASYMPTOMATIC BACTERIURIA AND ITS ASSOCIATION WITH URINARY TRACT ANOMALIES IN CHILDREN AGED 5 TO 12 YEARS: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Abstract

Background: Asymptomatic bacteriuria (ASB) in children is often overlooked but may serve as an early marker of underlying urinary tract anomalies. Early detection through school-based screening could facilitate timely diagnosis and management, particularly in resource-limited settings.

Objectives: To determine the prevalence of asymptomatic bacteriuria among school-aged children (5–12 years) and to evaluate its association with structural anomalies of the urinary tract.

Methods: A cross-sectional observational study was conducted among 500 asymptomatic school-going children aged 5 to 12 years, selected from government and private schools. Clean-catch midstream urine samples were collected and screened using dipstick tests and urine culture. Children with culture-confirmed ASB (≥10⁵ CFU/mL of a single uropathogen) underwent renal ultrasonography (USG). Further diagnostic imaging with micturating cystourethrogram (MCU) or DMSA scan was performed as indicated. Data were analysed using chi-square tests and logistic regression to assess associations between ASB and demographic or anatomical variables.

Results: Out of 500 children, 17 tested positive for ASB, yielding a prevalence of 3.4% (95% CI: 2.0–5.4%). ASB was significantly more common in females (76%, p = 0.01). Escherichia coli was the most frequent isolate (70.6%), with high susceptibility to nitrofurantoin (94%) and moderate resistance to ampicillin (65%). Among ASB-positive cases, 6 children (35.3%) were found to have urinary tract anomalies, including hydronephrosis, vesicoureteral reflux (VUR), and duplex kidney systems. A significant association was found between ASB and structural anomalies (p< 0.001), while correlations with rural residence and younger age were not statistically significant.

Conclusion: ASB affects a measurable proportion of school-aged children, with a marked female preponderance and a strong association with underlying urinary tract anomalies. Screening for ASB, particularly in females, followed by imaging evaluation in positive cases, may serve as a valuable preventive strategy to reduce long-term renal morbidity in paediatric populations.