Prevalence of Asymptomatic Bacteriuria, Association of Patient-related Factors and Cancer-related Factors in Patients with Cancer, Attending Trail Cancer Hospital, Tellippalai, Sri Lanka.

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.