ABSTRACT:

Background: Sickle cell anaemia (SCA) is a common genetic disorder, which is distributed worldwide and estimated to affect a total of 275,000 children worldwide. SCA is a significant problem in Africa whereby 50-80% of children die before their fifth birthday. Blood stream infections (BSI) and Urinary tract infections significantly contribute to the morbidity and mortality in children with SCA. Despite the high prevalence of SCA in the Lake Zone, there is insufficiency data on the prevalence, and the associated factors, of blood and urinary tract infections among children with SCA.

Objectives: This study was designed to determine the prevalence of BSI and UTI and associated factors among symptomatic children with SCA attending at the Bugando Medical Centre, Mwanza-Tanzania.

Methodology: This was the hospital-based cross-sectional study. A total of 320 children aged 6 months-12 years with SCA attending at SCD clinic at BMC were enrolled. Demographic information and clinical presentation were collected using pre-tested questionnaires. Blood and urine culture were done following standard operating procedures. Isolates were identified using in house biochemical profile followed by antibiotic susceptibility testing as per Clinical Laboratory Standard Institute (CLSI). Data were analyzed using STATA version 13.

Results: A total of 320 children were enrolled and all included in the final analysis. The median age was 48 [Interquartile range (IQR: 30 – 84.5)] months. Male formed slightly majority 174(54.4%) of study participants. Most of the children 130(40.6%) enrolled were aged between 2 and 5years. Out of the 320 participants, 28(8.8%, 95% CI: 6.1-12.4) had BSI and 62(19.4% 95%CI: 15.4-24.1) had UTI. Escherichia coli and other gram negative bacterial isolates were predominant isolates from urine and blood, respectively. A total of 8.75% children were found to be infected with ESBL from urine. There were no Carbapenem resistant enterobacteriaceae (CRE) positive. E.coli isolates from urine were 90.9%, 75.6%, 66.7% 42.4%, 39%, 21.2%, 12.1%, 3% and 0% resistant to ampicillin, trimethoprim/ sulphamethoxazole, amoxicillin/clavulanic acid, gentamicin, ceftriaxone, amikacin, nitrofurantoin and meropenem respectively. While other gram negative bacterial isolates from blood were 73.7%, 73.7%, 68.4%, 42.1%, 31.5%, 10.5%, 10.5%, 10.5% and 5.3% resistant to ampicillin, trimethoprim/ sulphamethoxazole, amoxicillin/clavulanic acid, gentamicin, ceftriaxone meropenem, piperacillin/ tazobactam, amikacin and ciprofloxacin. A total of 2.81% children were found to be infected with ESBL from blood. Carbapenem resistant enterobacteriaceae (CRE) and Methicillin resistant Staphylococcus aureas (MRSA) positive from blood were 0.63% and 0.63%, respectively. Factors found independently to predict UTI were female sex (OR; 2.4, 95% CI 1.3-4.7, p=0.005), age below 2 years (OR; 6.6; 95% CI 2.8-16; p=<0.001), age between 2 -5 years (OR; 3; 95% CI 1.3 - 6.5; p=0.005) and living in rural areas (OR; 2.6, 95% CI 1.4-4.9, p=0.002).

Conclusion: BSI and UTI among children with SCA attending BMC are due to multi-resistant gram-negative bacteria. UTI in this population is predicted by female sex, children under five years of age and living in rural areas. Routine investigation followed by specific treatment for BSI and UTI should be emphasized among children with SCA. In addition, there is a need to collect more data that will be used to revise treatment guidelines for empirical treatment of BSI among children with SCA