Abstract:
Background: Cancer is one of the leading diseases in the world. Patients with cancer, especially
those immunocompromised, are at a higher risk of infection from untreated asymptomatic
bacteriuria (ABU), which can lead to complications such as sepsis followed by death.
Understanding the changing bacterial prevalence due to the clinical and socio-demographic
characteristics of patients with cancer is very important for optimizing treatments and lowering the
risk of complications in this vulnerable population.
Objectives: To determine the prevalence of ABU, and association of patient-related and cancer
related factors in patients with cancer attending Trail Cancer Hospital, Tellippalai, Sri Lanka
Methods: An institutional-based descriptive cross-sectional study was conducted at Trail Cancer
Hospital, Tellippalai, Sri Lanka, involving 245 patients with cancer without symptoms of urinary
tract infection (UTI). Patients were selected using the convenient sampling technique. Appropriate
urine samples were collected and inoculated on CLED media. Pure growth concentrations of ≥105
CFU/mL or 104-105 CFU/mL were considered culture-positive. Relevant biochemical tests were
performed to isolate the single organisms according to standard microbiological techniques. An
interviewer-administered questionnaire was used to collect data regarding patient-related factors
(age, occupation, gender, history of UTI, catheterization and genito-urinary surgery, etc.) and
cancer-related factors (cancer type, stage, treatment method, etc.). The data were analysed using
SPSS version 20.0.
Results: Among the 245 patients with cancer, 26.5% (n=65) were in-patients (hospitalized
patients), and 73.5% (n=180) were out-patients (clinic patients). Of the patients, 55.9% were
female, and 44.1% were male, with a mean±SD age of 56±0.73 years. About 8.2% of the total
population showed significant bacterial growth. Among the population patients with
haematological cancer showed the highest (25%) bacterial growth. A higher prevalence was
observed among in-patients (13.85%) compared to out-patients (6.11%). Coliforms were the most
frequently isolated bacteria (55%), followed by Pseudomonas sp. (15%), Coagulase-negative
Staphylococcus (15%), Acinetobacter sp. (10%), and Streptococcus sp. (5%). Patient-related
factors such as age [p=0.01; >65 years (60% of patients with ABU)] and 44-65 years (35% of
patients with ABU), occupation (p=0.019), and history of previous UTIs (p=0.029) were
statistically associated with ABU at a significance level of p<0.05, while none of the cancer
related factors were statistically associated with ABU.
Conclusion: The prevalence of ABU was considerably higher among in-patients than out-patients,
with Coliforms being the predominant uropathogen. ABU predominantly affected older
individuals with cancer, which could be attributed to weakened immune responses in elderly.