Background
Methods
Search strategy and selection criteria
Inclusion and exclusion criteria
Quality assessment
Data extraction
Data analysis
A meta-analysis of prevalence studies
A meta-analysis of association studies
Results
Study selection
Characteristics of included articles
Source | Country of study | Study setting and period | Study population | Study design |
---|---|---|---|---|
Philips I et al. 1968 [41] | Uganda | Infantile Malnutrition Research Unit, Medical Research Unit, Kampala. Study period not specified | 75 malnourished children admitted consecutively over a nine-month period. Age range not specified | Cross-sectional |
Brooke O. G et al. 1973 [57] | Jamaica | Tropical Metabolism Research Unit, University of West Indies. Study period not specified | 95 malnourished children (39 females; 56 males) admitted over an 18-month period, aged 4–35 months (mean 12.6 months) | Cross-sectional |
Buchanan N et al. 1973 [34] | South Africa | Baragwanath Hospital, Johannesburg. Study period not specified | 30 admitted malnourished children aged 7–36 months (mean of 15 months) | Cross-sectional |
Morehead D et al. 1974 [53] | Thailand | Anemia and Malnutrition Research Centre, Chang Mai Hospital, Chang Mai between June 1969 and April 1970 | 35 consecutively admitted malnourished children (18 females; 17 males) aged 10–50 months (mean of 22 months) | Cross-sectional |
Brown KH et al. 1981 [52] | Bangladesh | Children’s Nutrition Unit, Dacca, between January 1976 and April 1976 | 100 admitted (50 males and 50 females) children aged 18–30 months (median 20 months) | Cross-sectional |
Morton RE et al. 1982 [40] | Nigeria | Pediatric out-patient department of Ahmadu Bello University Teaching Hospital, Zaria. Study period not specified | 65 malnourished children visiting the outpatient clinic over a six-month period, aged 0–120 months | Cross-sectional |
Berkowitz FE 1983 [15] | South Africa | General Pediatric wards of Baragwanath hospital, Johannesburg between December 1981 and November 1982 | 16 admitted malnourished children (part of 68; 35 males and 33 females) aged 4–48 months (mean 16.9 months) | Cross-sectional |
Oyedeji G 1989 [39] | Nigeria | Children’s ward, Wesley Guild Hospital Ilesha, between January 1985 and December 1986 | 73 admitted malnourished children (30 females; 43 males) aged 12–96 months (mean 22.6 months) | Cross-sectional |
Isaack H et al. 1992 [44] | Tanzania | Pediatric wards of Muhimbili Hospital Dar es Salaam. Study period not specified | 164 admitted malnourished children (89 males, 75 females) aged 2–59 months (mean 19 months) who had not been on any antibiotics in the previous 24 h, and studied over a two-week period. | Prospective; Cross-sectional. |
Kala UK et al. 1992 [13] | South Africa | Baragwanath Hospital, Johannesburg. Study period not specified. | 75 consecutively-admitted malnourished children (44 males, 31 females) aged 3–60 months (mean 15.4 months) | Cross-sectional |
Ighogboja et al. 1993 [38] | Nigeria | Children’s ward, Jos University Teaching Hospital between January 1991 and December 1991 | 130 admitted malnourished children (52 females; 78 males) aged 11–96 months (mean 22.8 months) | Cross-sectional |
Shimeles D et al. 1994 [16] | Ethiopia | Ethio-Swedish Children’s Hospital, Addis Ababa, between January 1 and December 31, 1992 | 19 children (part of 90 admitted malnourished children, 40 males, and 50 females) Aged 4–60 months (median 15 months) | Cross-sectional |
Reed P et al. 1995 [14] | South Africa | Shongwe Mission Hospital, Shongwe, Malelane between September 1992 and April 1993 | 134 presenting malnourished children (73 males, 61 females) aged 1–59 months (median 17 months) not using antibiotics in the previous 24 h | Prospective; Cross-sectional |
Ekanem EE et al. 1997 [37] | Nigeria | University Teaching Hospital Calabar. Study period not specified | 27 children (part of 37 admitted malnourished children aged 3–60 months (mean 22 months) recruited for a case-control study on differences in CRP and C3 levels in protein-energy malnutrition with and without infection) | Cross-sectional |
Caksen H et al. 2000 [46] | Turkey | Department of Pediatrics, Yüzüncü Yil University, between May 1998 and November 1998 | 103 admitted malnourished children aged 1.6–30 months (mean 11.6 months) | Cross-sectional |
Rabasa AI et al. 2002 [11] | Nigeria | Pediatric wards of University of Maiduguri Teaching Hospital between January 1994 and December 1996 | 194 admitted malnourished children (128 males and 66 females) aged 3–60 months (mean 17.6 months) | Cross-sectional |
Russell B et al. 2004 [55] | Australia | Alice Springs Hospital, Alice Springs between January 2000 and September 2001 | 55 admitted malnourished Central Australian Indigenous children aged 0.6-41 months (mean of 8.6 months) sampled from medical records | Retrospective cross-sectional |
Noorani N et al. 2005 [43] | Kenya | Pediatric Filter Clinic of Kenyatta National Hospital, Nairobi between March 2003 and October 2003 | 91 consecutively presenting malnourished children (45 males, 46 females) aged 2–60 months (mean 18 months) | Cross-sectional |
Bachou H et al. 2006 [42] | Uganda | Pediatric wards of Mulago Hospital, Kampala between September–November 2003 and September–December 2004 | 315 consecutively admitted malnourished children (196 males,119 females) with a median age of 17 months | Cross-sectional |
Okomo UA et al. 2011 [19] | The Gambia | Pediatric ward, Medical Research Council Hospital, Fajara, between November 2007 and December 2008 | 97 children (part of 140 admitted malnourished children aged 6–59 months (median 19.1 months) without non-nutritional causes of edema, chronic infection or antibiotic use in the previous two weeks | Prospective; Cross-sectional |
Suliman OSM et al. 2011 [45] | Sudan | Pediatric wards of the Khartoum Teaching Hospital and Soba University Teaching Hospital between December 1992 and May 1993 | 49 admitted malnourished children aged 6–60 months (mean 22 months) | Cross-sectional |
Page A et al. 2013 [12] | Niger | intensive therapeutic feeding center in the Maradi region between November 2007 and July 2008 | 300 (out of a total of 311 admitted malnourished children (170 males and 141 females) aged 6–59 months (median 13 months) | Cross-sectional |
Sameen I and Moorani N 2014 [50] | Pakistan | Nutritional Rehabilitation Unit, National Institute of Child Health, Karachi between January 2012 and June 2012 | 130 admitted malnourished children (78 males and 52 females) aged 1–59 months (mean: 16.8 months) | Cross-sectional |
Ahmed M et al. 2015 [18] | Tanzania | Pediatric wards of Bugando Medical Centre, Mwanza between September 2012 and January 2013 | 402 admitted malnourished children (173 males and 229 females) aged 6–60 months (median 17 months) | Cross-sectional |
Anjum M et al. 2016 [51] | Pakistan | Nutritional Rehabilitation Unit of National Institute of Child Health, Karachi between October 2014 and March 2015 | 78 admitted malnourished children (39 males and 39 females) aged 2–60 months (mean 18 months) | Cross-sectional |
Thuo N et al. 2017 | Kenya | pediatric ward at the Centre for Geographical Medicine Research, Coast between June 2005 and June 2007 | 498 admitted malnourished children (271 males, 227 females) with a median age of 22.4 months | Prospective; Cross-sectional |
Buchanan N et al. 1971 [34] | South Africa | Baragwanath Hospital, Johannesburg. Study period not specified | 125 outpatient children [75 malnourished (5 females; 70 males) and 50 controls (5 females; 45 males)] without urinary tract signs or symptoms, studied over two months. The age range of malnourished children was 8–96 months (mean 43 months), and the age range of controls was 2–108 months (mean 30 months) | Case-control |
Freyre EA et al. 1973 [56] | Peru | Department of Pediatrics, Universidad Nacional de San Agustin, Arequipa. Study period not specified | 200 malnourished children (108 females and 92 males) and 118 controls (61 females and 57 males) outpatients and admitted patients, aged 3–36 months (mean 20 months) | Case-control |
Bodaghi E et al.1978 [54] | Iran | Children’s Hospital Medical Center, Tehran. Study period not specified | 667 outpatient or admitted children (348 malnourished [143 females; 205 males] and 319 controls [140 females; 174 males] aged 2–24 months and not having any antimicrobial therapy in the past 48 h. | Prospective; Case-control |
Banarpurmath C et al. 1994 | India | Pediatric wards and Out-patient Department, Chigateri General Hospital, Devangere, between April 1989 and April 1990 | 141children [88 admitted malnourished children selected from the Pediatric wards and 53 out-patient controls aged 12–60 months | Case-control |
Jeena PM et al. 1995 [36] | South Africa | King Edward VIII Hospital, Durban in November 1992 | 32 malnourished children and 148 controls aged 0–144 months | Case-control |
Caksen H et al. 2001 [47] | Turkey | Department of Pediatrics, Yüzüncü Yil University, Study period not specified | 146 admitted malnourished children (69 females; 77 males) [47 malnourished and 99 controls] without symptoms suggesting urinary tract infection, aged 0.9–15 months (mean 4.6 months) | Case-control |
Bagga A et al. 2003 [4] | India | All India Institute of Medical Sciences, New Delhi between September 1997 and July 1998 | 224 consecutive out-patient children (112 malnourished [47 females; 65 males] and 112 controls [47 females; 65 males]) aged 6–60 months (mean of 35.5 months) | Case-control |
Gopal G and Premalatha R 2014 [49] | India | Department of Pediatrics, Mysore Medical College and Research Institute, Mysore between November 2008 and August 2010 | 250 children (150 admitted malnourished (93 males and 57 females) and 100 outpatient controls (55 males and 45 females)) aged 6–60 months (mean 27 months) | Case-control |
Source | Definition of malnutrition | Degree of malnutrition | Urine sampling method | Urinalysis method | Definition of UTI |
---|---|---|---|---|---|
Cross-sectional studies | |||||
Philips I et al. 1968 [41] | Marasmus or kwashiorkor | Severe malnutrition, including kwashiorkor (84%) and marasmus (16%). | urine bag or suprapubic aspiration (if specimen using bag is contaminated) | Culture (details not specified) | Not specified |
Brooke O. G et al. 1973 [57] | Protein-energy malnutrition | Severe malnutrition (100%) | Sterile urine bags or suprapubic tap | microscopy and culture (details not specified) | > 10000 organisms/ml of urine confirmed by suprapubic tap (if a bad specimen was initially used) |
Buchanan N et al. 1973 [35] | Kwashiorkor, marasmic kwashiorkor, marasmus or underweight for age (below the third percentile) | Severe malnutrition including Kwashiorkor: 46.7%), marasmic Kwashiorkor (23.3%), Marasmus (20%) and Underweight for age (10%) | Midstream urine or sterile urine bags | Uricult dip-slide (nutrient agar on one side and McConkey’s agar on the other side, with 13 cm2 areas for each medium) incubated at 37 °C for 16–24 h. | > 105 organisms/ml of urine |
Morehead D et al. 1974 [53] | Kwashiorkor, marasmus or marasmic kwashiorkor | Moderate/severe malnutrition including marasmus: (22.9%) marasmic kwashiorkor (51.4%) and Kwashiorkor (25.7%). | Suprapubic tap or urethral catheterization | Plating on sheep blood and McConkey agar within one hour of the collection (or immediately put in a refrigerator to be plated within 24 h) and Gram staining of urine samples | > 105 organisms/ml of urine |
Brown KH et al. 1981 [52] | Marasmus, marasmic kwashiorkor or kwashiorkor | Severe malnutrition including marasmus (57.1%), marasmic kwashiorkor (28.6%) and kwashiorkor (14.3%). | Suprapubic aspiration or freshly voided specimen | Microscopy and culture (details not specified) | ≥105 colonies/ml of urine (mid-stream) or ≥ 1 organism (suprapubic aspiration) |
Morton RE et al. 1982 [40] | Kwashiorkor or marasmus | Severe malnutrition, including kwashiorkor (52.3%) and marasmus (47.7%). | Suprapubic aspiration and mid-stream urine. | Culture using McConkey and blood agar for 18 h | Any growth from suprapubic aspiration or ≥ 105 from mid-stream urine |
Berkowitz FE 1983 [15] | Marasmus, marasmic kwashiorkor and kwashiorkor | Severe malnutrition including kwashiorkor (68%), marasmus (12%) and marasmic Kwashiorkor (20%). | Suprapubic aspiration | Microscopy and culture (details not specified). | ≥One organism/ml of urine |
Oyedeji G 1989 [39] | Marasmus, kwashiorkor or marasmic kwashiorkor, plus at least one feature of the disease compelling hospitalization (severe dermatoses with extensive wet areas, severe edema, intractable diarrhea, intolerance of oral fluids and feeds, hypothermia and severe mental apathy) | Severe malnutrition, including kwashiorkor (67.1%) and marasmic Kwashiorkor (32.9%). | mid-stream urine or suprapubic tap | microscopy, culture (details not specified) and sensitivity | Not specified |
Isaack H et al. 1992 [44] | Marasmus, marasmic kwashiorkor or kwashiorkor | Severe malnutrition including marasmus (55.5%), kwashiorkor (23.8%) and marasmic kwashiorkor (20.7%). | Not specified | Urine culture using Mc Conkey’s and blood agar | Not specified |
Kala UK et al. 1992 [13] | Underweight, marasmus, kwashiorkor or marasmic kwashiorkor | All forms of malnutrition including underweight (29.3%), marasmus (13.3%), kwashiorkor (41.3%) and marasmic kwashiorkor (16%) | Suprapubic aspiration | Dip-slide cultures (Uricult®-Boehringer Mannheim and incubated at 37 degrees C for 24-48 h) and microscopy | Presence of any growth on dip-slide culture |
Ighogboja et al. 1993 [38] | Marasmus, kwashiorkor or Marasmic-kwashiorkor | Severe malnutrition, including marasmic kwashiorkor (46.2%), kwashiorkor (29.2%) and marasmus (24.6%). | Mid-stream urine or suprapubic tap | Microscopy, culture (medium not specified) and sensitivity | Not specified |
Shimeles D et al. 1994 [16] | Marasmus, Marasmic-Kwashiorkor or Kwashiorkor | Severe malnutrition, including marasmus (48.9%), kwashiorkor (18.9%) and marasmus (32.2%). | Suprapubic aspiration or sterile bags | Microscopy and culture (details not specified) | Not specified |
Reed P et al. 1995 [14] | Nutritional dwarfism, kwashiorkor, marasmus or Marasmic Kwashiorkor | All including kwashiorkor (53.7%), nutritional dwarfism (32.8%), marasmus (8.2%) and marasmic kwashiorkor (5.2%). | Suprapubic aspiration | Dipstick urinalysis for leukocytes and nitrites using Combur-9 strips (Boehringer Mannheim); Culture in cystine lactose electrolyte deficient medium, blood agar and McConkey agar (Bio Lab media, Merck Ltd., Johannesburg) incubated at 37 degrees overnight; Antimicrobial Sensitivity using Kirby-Bauer disk-diffusion method. | Any growth from suprapubic aspiration |
Ekanem EE et al. 1997 [37] | Kwashiorkor, marasmus or marasmic-kwashiorkor | Severe malnutrition including kwashiorkor (51.9%), marasmus (25.9%) and marasmic-kwashiorkor (22.2%) | Not specified | Urine culture (medium not specified) | Not specified |
Caksen H et al. 2000 [46] | Weight for age below the 90th percentile (Grade I: 76–90% or Grade II: 61–75% or Grade III: < 60%) | Mild to severe malnutrition (100%) | Not specified | microscopy and culture (details not specified) | ≥105 colonies/ml of urine with the same organism |
Rabasa AI et al. 2002 [11] | Marasmus, marasmic kwashiorkor and kwashiorkor | Severe malnutrition including marasmus (67%), marasmic kwashiorkor (13.4%) and kwashiorkor (19.6%). | Suprapubic aspiration | Culture on McConkey’s agar, cysteine lactose electrolyte deficient medium and incubated 18-24 h at 37.1 °C and sensitivity using the disc method | ≥One organism/ml of urine. |
Russell B et al. 2004 [55] | Weight loss resulting in downwards crossing of two major percentile lines or no weight gain (weight and weight for age z-score) | Mild/ moderate/ severe (76% gained no weight in the past 2–3 months, and 24% crossed down two major percentile lines) | Not specified | Not specified | Not specified |
Noorani N et al. 2005 [43] | Kwashiorkor, marasmus or marasmic-kwashiorkor | Severe malnutrition including kwashiorkor (22%), marasmus (66%), and marasmic-kwashiorkor (12%) | Suprapubic aspiration | Urine culture using CLED medium incubated overnight and sensitivity using diffusion technique | Not specified |
Bachou H et al. 2006 [42] | Presence of edema and/or weight for height z score > −3 of the NCHS/WHO reference values | Severe malnutrition including severe wasting (45.4%) and edematous malnutrition (54.6%) | Not specified | Urine culture and sensitivity | Not specified |
Okomo UA et al. 2011 [19] | Very low weight for height (below −3z scores of the median NCHS/WHO growth standards, visible severe wasting, or the presence of nutritional edema. | Severe acute malnutrition (32.1% had edema with or without weight for height below -3SD) | Suprapubic aspiration (if < 12 months) or urethral catheterization or clean-catch sample (children > 12 months or in cases of dry suprapubic tap). | Microscopy, culture (cysteine lactose electrolyte deficient (CLED) agar incubated overnight at 37 degrees) and sensitivity | ≥105 colonies/ml of urine (mid-stream) or ≥ 1 organism/ml of urine (suprapubic aspiration) |
Suliman OSM et al. 2011 [45] | Kwashiorkor, marasmus or marasmic-kwashiorkor | Severe malnutrition including marasmus (46.9%), marasmic-kwashiorkor (34.7%) and kwashiorkor (18.4%) | Not specified | Urine microscopy, culture, and sensitivity | ≥Five pus cells/HPF and/or positive cultures |
Page A et al. 2013 [13] | Weight-for-height < 3z scores of the median WHO growth standards and/or mid-arm circumference, 110 mm and/or bipedal edema. Complicated malnutrition if accompanied by anorexia and/or Kwashiorkor with bilateral pitting edema and/or another severe condition. | Severe malnutrition with 15.4% being edematous | Foley catheter | Dipstick urinalysis, Culture using CHRO Magar inoculation plate and sensitivity using Kirby Bayer disk diffusion method on Mueller-Hinton agar. | Single pathogen ≥104/ml (Escherichia coli) or ≥ 105/ml (others) regardless of the number of leukocytes in urine OR bacteriuria ≥103/ml (Escherichia coli) or 104/ml (others in the presence of at least 104 leukocytes/ml in the urine |
Sameen I and Moorani N 2014 [50] | Weight for height Z scores (below -3 SD with or without bilateral pitting edema and any of the following: anorexia, severe anemia, high fever, severe dehydration, and systemic infection. | Severe malnutrition including severe wasting (80.8%) and edematous malnutrition (19.2%) | Not specified | Urine culture and sensitivity | Not specified |
Ahmed M et al. 2015 [18] | Weight-for-height < 3 SD of the z score according to WHO Classification (Mild (−1 SD) or moderate (−2 SD) or severe (−3SD) | All. Mild (36.6%), moderate (19.2%) and severe (44.3%) | Mid-stream urine (if > 24 months) or suprapubic aspiration (if < 24 months) | Culture (cysteine lactose electrolyte deficient agar (CLED), MacConkey and blood agar plates (Oxoid UK) incubated at 37 degrees for 24 h. Drug susceptibility using disc diffusion method | Any growth from suprapubic aspiration or ≥ 105/ml of mid-stream urine |
Anjum M et al. 2016 [51] | Presence of bilateral pitting edema or weight for height z score > − 3 of the NCHS/WHO reference values | Severe malnutrition including marasmus (82%) and edematous malnutrition (18%) | Not specified | Microscopy and culture | Not specified |
Thuo N et al. 2017 | Pedal edema (kwashiorkor or marasmic kwashiorkor) or weight for height Z score ≤ − 3 or mid-arm circumference < 11 cm (if length > 65 cm) | Severe (36% with edema) | Mid-stream urine | Microscopy, culture in cystine lactose electrolyte deficient agar at 37 degrees and sensitivity | Growth of a single pathogen at ≥50 colony forming units/μl |
Case-control studies | |||||
Buchanan N et al. 1971 [34] | Atrophic malnutrition or kwashiorkor | Moderate/severe malnutrition including kwashiorkor: (33.3%) and atrophic malnutrition: (66.7%) | midstream urine or sterile urine bags or suprapubic aspiration | Uricult dip-slide (nutrient agar on one side and McConkey’s agar on the other side, each medium covering 13 cm2 slide area) incubated at 37 °C for 16–24 h. Confirmation using conventional pour plate method for suprapubic urine specimen | > 105 organisms/ml of urine |
Freyre EA et al. 1973 [56] | Marasmus, Marasmic Kwashiorkor or Kwashiorkor | Severe malnutrition including marasmus (39%), kwashiorkor (20%) and marasmic kwashiorkor (41%). | Sterile plastic urine collector | Culture using the Henrich method | ≥105 colonies/ml of urine |
Bodaghi E et al.1978 [54] | Less than 75% standard weight for age (Grade I: 70–75%; Grade II: 60–70%; Grade III: 50–60%; Grade IV: 40–50%) | Mild /moderate /severe including Grade I (20%), Grade II (20%), Grade III (33%) and Grade IV (27%) | Sterile urine bags | Culture on blood, nutrient and eosin methylene blue agar media | 2–3 consecutive specimen revealing 105 colonies/ml of urine with the same organism of the same serotype |
Banarpurmath C et al. 1994 | Weight for age of < 60% (Grade I: 71–80% or Grade II: 61–70% or Grade III: 51–60% or Grade IV: < 50%) | Severe malnutrition including Grade III (70.5%) and Grade IV (29.5%). | Suprapubic aspiration (children < 3 years old) and mid-stream urine (> 3 years) | Direct microscopic examination, gram stain, and culture (details not specified) | ≥105 colonies/ml of urine (mid-stream) or ≥ 1 organism (suprapubic aspiration) |
Jeena PM et al. 1995 [36] | Protein-energy malnutrition defined according to conventional clinical features | All (groups not specified) | Urethral catheterization, suprapubic aspiration or clean-catch sample | microscopy, culture, and sensitivity | ≥105 colonies/ml of urine (mid-stream or clean catch) or > 103 organisms (suprapubic aspiration); |
Caksen H et al. 2001 [47] | Weight for age below the 90th percentile (Grade I: 76–90% or Grade II: 61–75% or Grade III: < 60%) | Mild to severe malnutrition (combined Grade I-III: 31%) | Sterile urine bags | Urine microscopy and culture (sheep agar and eosin methylene blue agar plates incubated at 35 °C for 24–48 h) | Two consecutive specimens revealing 105 colonies/ml of urine with the same organism |
Bagga A et al. 2003 [4] | < 80% weight for age (Grade I: 71–80% or Grade II: 61–70% or Grade III: 51–60% or Grade IV: < 50%) | Moderate/ severe, including Grade II (49.1%), Grade III (45.5%) and Grade IV (5.4%). | Suprapubic tap or clean-catch | Microscopy (WBC counting using a Neubauer counting chamber; and Gram staining) and culture | Any growth on urine specimen collected by suprapubic aspiration or > 105 organisms/ml of clean-catch urine |
Gopal G and Premalatha R 2014 [49] | Less than 70% of the expected weight for age (Grade II: 60–69.9% or Grade III: 50–59.9% or Grade IV: < 50%) | Moderate to severe malnutrition including Grade II (34%), Grade III (37%) or Grade IV (29%) malnutrition | Suprapubic aspiration (if < 36 months) and clean catch (if ≥36 months) | Urine microscopy and culture (culture medium not specified) | > 5 pus cells/high power field or a positive urine culture |
UTI prevalence in malnourished children
Variable | Subgroup | N | Prevalence | Within-group heterogeneity estimates | Between-group heterogeneity estimates | |||
---|---|---|---|---|---|---|---|---|
% (95% CI) | Q-statistic | P-value | I2 (%) | Q-statistic | P-value | |||
Sex | Males | 6 | 23% (14, 32%) | 30 | < 0.001 | 83.2 | 0.3 | 0.61 |
Females | 6 | 20% (14, 27%) | 14 | 0.01 | 64.8 | |||
Age | < 18 months | 13 | 18% (13, 23%) | 109 | < 0.001 | 87.8 | 0.2 | 0.21 |
≥18 months | 13 | 16% (10, 23%) | 74 | < 0.001 | 87.3 | |||
Year of publication | < 2000 | 14 | 21% (16, 26%) | 52 | < 0.001 | 74.9 | 1.6 | 0.06 |
≥2000 | 12 | 14% (9, 19%) | 129 | < 0.001 | 91 | |||
Malnutrition severity | Severe | 20 | 15% (11, 19%) | 129 | < 0.001 | 91.4 | 3.6 | 0.01 |
Mixed | 6 | 25% (19, 32%) | 17 | < 0.001 | 70.4 | |||
Region | Africa | 19 | 21% (17, 25%) | 137 | < 0.001 | 86.9 | 0.2 | 0.68 |
Others | 7 | 16% (7, 27%) | 64 | < 0.001 | 90.6 | |||
Study quality | Low | 23 | 17% (12, 22%) | 171 | < 0.001 | 87.2 | 0.9 | 0.33 |
High | 3 | 21% (16, 26%) | n.a. | n.a. | n.a. | |||
Sample size | < 50 | 6 | 27% (18, 36%) | 9 | 0.11 | 44.2 | 5.8 | 0.02 |
≥50 | 20 | 16% (12, 20%) | 178 | < 0.001 | 89.3 | |||
Urine sampling | One method* | 6 | 14% (7, 22%) | 53 | < 0.001 | 90.5 | 1.1 | 0.29 |
Multiple methods/ not specified | 20 | 18% (14, 23%) | 112 | < 0.001 | 83.1 |
Variable | Subgroup | Bivariate model | Adjusted R2 (%) | Multivariable model | Adjusted R2 (%) |
---|---|---|---|---|---|
OR (95% CI) | OR (95% CI) | ||||
Malnutrition severity | Mild or mixed | Ref. | 24.06 | Ref. | 34.63 |
Moderate/Severe | 0.90 (0.83, 0.99)** | 0.90 (0.83, 0.97)** | |||
Sample size | < 50 | Ref. | 5.77 | Ref. | |
≥50 | 0.91 (0.82, 1.01)* | 0.92 (0.83, 1.02) | |||
Year of publication | < 2000 | Ref. | 5.79 | Ref. | |
≥2000 | 0.94 (0.87, 1.01)* | 0.95 (0.89, 1.02) | |||
Age | < 18 months | Ref. | 2.17 | – | |
≥18 months | 0.95 (0.88, 1.03) | – | |||
Urine sampling | Multiple/unspecified method | Ref. | −0.53 | – | |
One method | 0.96 (0.87, 1.05) | – | |||
Study quality | Low | Ref. | −1.76 | – | |
High | 1.04 (0.92, 1.17) | – | |||
Region | Others | Ref. | −3.77 | – | |
Africa | 1.02 (0.93, 1.12) | – |
Risk of UTI in malnourished children vs. healthy controls
Bacterial isolates and antibiotic-sensitivity patterns
Source | Prevalence of UTI | Subgroup differences | Bacterial Isolates | Antibiotic sensitivity |
---|---|---|---|---|
Cross-sectional studies | ||||
Philips I et al. 1968 [41] | 10.7% | Not specified | Escherichia coli (75%); Proteus species (12.5%); Klebsiella spp (12.5%). | Not done |
Brooke O. G et al. 1973 [57] | 9.5% | Males:12.5%; Females: 5.1% | Escherichia coli (44.5%); Klebsiella spp (44.5%); Proteus spp (11%) | Not done |
Buchanan N et al. 1973 [35] | 30% | Not specified | Escherichia coli (55.6%); Klebsiella spp (22.2%); Proteus mirabilis (22.2%) | Not done |
Morehead D et al. 1974 [53] | 34.3% | Not specified | Escherichia coli (58.3%); Enterobacter spp (25%); Proteus mirabilis (16.7%); Proteus spp (8.3%); Klebsiella spp (8.3%); Staphylococcus aureus (8.3%); Microaerophilic streptococci (8.3%); Streptococcus fecalis (8.3%); Non-hemolytic streptococci (8.3%) | Escherichia coli; cephalothin (8%), ampicillin (4%), tetracycline (18%), kanamycin (30%), colistin (75%), gentamicin (68%) and chloramphenicol (14%). Klebsiella spp, Proteus spp and Enterobacter spp also had low sensitivity to all antibiotics. Staphylococcus aureus; Cephalothin (100%), kanamycin (90%) and gentamicin (98%), but less sensitive to the other antibiotics |
Brown KH et al. 1981 [52] | 30% | Males: 24%; Females: 36% | Escherichia coli (96%); Pseudomonas spp (4%) | Not done |
Morton RE et al. 1982 [40] | 23% | Not specified | Escherichia coli (48%); Klebsiella spp (39%); Citrobacter spp (5%). | Not done |
Berkowitz FE 1983 [15] | 31% | Not specified | Escherichia coli (100%) | Not done |
Oyedeji G 1989 [39] | 11% | Not specified | Escherichia coli (25%); Klebsiella spp (75%) | Not done |
Isaack H et al. 1992 [44] | 21% | Escherichia coli (52.9%); Klebsiella spp (41.2%); Pseudomonas spp (2.9%); Other coliforms (2.9%). | Escherichia coli and Klebsiella spp; Gentamycin (100%), cotrimoxazole (15, 14%), nitrofurantoin (26, 22%); Klebsiella spp; Chloramphenicol (100%). Escherichia coli; Chloramphenicol (8%) and penicillin (0%). | |
Kala UK et al. 1992 [13] | 35% | Males: 47.7%; Females: 16.1%. Underweight: 31.8%; Marasmus: 10%; Kwashiorkor: 41.9%; and Marasmic Kwashiorkor: 41.7%. | Escherichia coli (84.6%); Proteus mirabilis (7.7%); Klebsiella pneumoniae (3.8%); Pseudomonas aeruginosa (3.8%). | Not done |
Ighogboja et al. 1993 [38] | 12.3% | Not specified | Escherichia coli (37.5%); Klebsiella spp (37.5%); Pseudomonas spp (18.8%); Candida albicans (6.2%) | Sensitive to gentamicin, cefuroxime axetil, ceftazidime and ofloxacin |
Shimeles D et al. 1994 [16] | 37% | Not specified | Escherichia coli (42.9%); Klebsiella pneumoniae (42.9%) (3/7); Citrobacter spp (14.3%) | Not done |
Reed P et al. 1995 [14] | 26% | Males: 30.1%; Females: 21.3%. Nutritional dwarfism: 29.5%; Marasmus: 18.2%; Kwashiorkor: 23.6%; and Marasmic kwashiorkor: 42.9%. | Escherichia coli (42.9%); Enterobacter spp (14.3%); Klebsiella spp (14.3%); Citrobacter spp (8.6%); Hafnia alvei (2.8%); Proteus mirabilis (2.8%); Pseudomonas spp (2.8%); Serratia spp (2.8%); Salmonella typhi (2.8%). S aureus (2.8%); Enterococcus faecalis (2.8%) | Escherichia coli; Nalidixic acid (100%), nitrofurantoin (92.3%), cephradine (84.6%), gentamicin (84.6%), cotrimoxazole (0%) and amoxicillin (7.7%). Enterobacter spp; Gentamicin (100%), cephradine (100%), nalidixic acid (100%), nitrofurantoin (60%), cotrimoxazole (40%) and amoxicillin (0%). Klebsiella spp; Nitrofurantoin (100%), nalidixic acid (100%), cephradine (80%), gentamicin (80%), cotrimoxazole (0%) and amoxicillin (20%). Citrobacter spp; Gentamicin (100%), cephradine (100%), nalidixic acid (100%) and nitrofurantoin (100%), amoxicillin (0%), cotrimoxazole (0%). Other gram negatives; Gentamicin (100%), cephradine (100%) and nalidixic acid (100%). Staphylococcus aureus; Amoxicillin (100%), gentamicin (100%), cephradine (100%), nitrofurantoin (100%) cotrimoxazole (0%) and nalidixic acid (0%). Enterococcus faecalis; Amoxicillin (100%), cotrimoxazole (100%), nalidixic acid (100%), nitrofurantoin (100%), gentamicin (0%) and cephradine (0%). |
Ekanem EE et al. 1997 [37] | 7.4% | Not specified | Klebsiella spp (50%); Pseudomonas spp (50%). | Not done |
Caksen H et al. 2000 [46] | 30.1% | No significant difference between UTI and degree of malnutrition | Escherichia coli (54.8%): Klebsiella pneumoniae (9.6%); Proteus mirabilis (9.6%); Enterobacter cloacae (6.4%); Klebsiella oxitoca (6.4%); Morganella morganii (3.2%); Citrobacter freundii (3.2%); Enterobacter aerogenes (3.2%); Salmonella spp (3.2%) | All isolates sensitive to gentamicin (100%). Escherichia coli and Klebsiella spp; Cotrimoxazole (18 and 20%), ceftriaxone (82 and 100%), cefotaxime (82 and 100%) and ciprofloxacin (82 and 100%) respectively. |
Rabasa AI et al. 2002 [11] | 11.35% | Kwashiorkor:10.5%; Marasmus: 10.1%; Marasmic kwashiorkor: 15.3% | E. coli (45.4%); Klebsiella spp (27.3%); Pseudomonas spp (13.6%); Staphylococcus aureus (13.6%) | 95% of Gram negatives were sensitive to gentamycin and/or ofloxacin; Staphylococcus aureus sensitive to gentamycin, co-trimoxazole, ceftazidime, and clavulanic acid potentiated amoxicillin (Augmentin®). All gram negatives showed poor sensitivity to co-trimoxazole and nitrofurantoin. |
Russell B et al. 2004 [55] | 11% | Not specified | Not specified | Not done |
Noorani N et al. 2005 [43] | 7.6% | Not specified | Klebsiella spp (57%); E. coli (43%). | Klebsiella spp and Escherichia coli; Amikacin (100%), ceftriaxone (100%), ciprofloxacin (100%), ampicillin (0%), ceftazidime (83.3%), cefuroxime (83.3%; 50%), chloramphenicol (0%; 66.7%), cotrimoxazole (16.7%; 0%) and gentamicin (66.7%; 83.3%). |
Bachou H et al. 2006 [42] | 25.7% | HIV-positive: 30%; HIV- negative: 23% | Not done | Not done |
Okomo UA et al. 2011 [19] | 16.5% | Escherichia coli (58.8%); Klebsiella spp (17.6%); Enterobacter cloacae (5.9%); Proteus spp (5.9%); Providencia alkali (5.9%); Pseudomonas aeruginosa (5.9%). | Escherichia coli; Gentamicin (100%), ciprofloxacin (100%), cefuroxime (100%), cefotaxime (100%), nitrofurantoin (100%), chloramphenicol (77%), ampicillin (0%) and cotrimoxazole (0%). | |
Suliman OSM et al. 2011 [45] | 28.5% | Not specified | Not done | Not done |
Page A et al. 2013 [12] | 16% | Males: 12.2%; Females: 20.6%. Age < 12 months: 24%; Age > 12 months: 10.9%. Fever: 16.7%; No fever: 15.9%. | Escherichia coli: 77%; Klebsiella pneumoniae: 14.6%; Proteus mirabilis: 4.2%; Proteus penneri: 2.1%; Enterococcus faecium: 2.1% | Escherichia coli; amoxicillin (0%), cotrimoxazole (5%), amoxicillin-clavulanic acid (39%), cephalothin (56%), cefoxitine (95%) cefotaxime (95%), ceftazidime (95%), imipenem (100%), gentamicin (90%) amikacin (100%) nalidixic acid (88%), ofloxacin (90%) and Extended Spectrum Beta-Lactamase (ESBL; 95%); Klebsiella spp; Amoxicillin (0%), cotrimoxazole (33%) amoxicillin-clavulanic acid (42%), cephalothin (58%), cefoxitine (92%) cefotaxime (92%), ceftazidime (92%), imipenem (100%), gentamicin (58%) amikacin (100%) nalidixic acid (100%), ofloxacin (100%) ESBL (92%) |
Sameen I and Moorani N 2014 [50] | 3.8% | Not specified | Not done | Not done |
Ahmed M et al. 2015 [18] | 20.65% | Males: 19.6%; Females: 21.4%. Fever: 22.6%; No fever: 18.4%. Mild malnutrition: 14.3%; Moderate malnutrition: 18.2%; Severe malnutrition: 27%. HIV-positive: 19.35%; HIV-negative: 20.75%. | Escherichia coli: 41.2%; Klebsiella pneumoniae: 23.8%; Other gram negatives (Proteus spp, Enterobacter spp, Citrobacter spp, Serratia spp): 34.5% | Escherichia coli; Ampicillin (3%) gentamicin (57%), ciprofloxacin (86%), amoxicillin/clavulanic acid (14%), ceftriaxone (66%), ceftazidime (60%) and etrapenem (97%). Klebsiella pneumoniae; Ampicillin (0%), Gentamicin (30%), ciprofloxacin (85%), amoxicillin/clavulanic acid (15%), ceftriaxone (50%), ceftazidime (40%) and etrapenem (100%); Others; Ampicillin (0%), gentamicin (34%), ciprofloxacin (97%), ceftriaxone (48%), ceftazidime (48%) and etrapenem (100%). |
Anjum M et al. 2016 [51] | 5% | Not specified | Not done | Not done. |
Thuo N et al. 2017 | 6% | Not specified | Coliforms (100%) | Cotrimoxazole (7%), gentamycin (57%), nalidixic acid (86%) and nitrofurantoin (79%). |
Case-control studies | ||||
Buchanan N et al. 1971 [34] | 4% | Not specified | Escherichia coli (67%); Proteus spp (33%) | Not done |
Freyre EA et al. 1973 [56] | 6% | Males: 4.3%; Females: 7.4%. No significant differences with the severity of clinical malnutrition. | Escherichia coli (76.5%). Others not reported. | Not done |
Bodaghi E et al.1978 [54] | 8.6% | Males:8.8%; Females: 8.4% | Escherichia coli (90%); Klebsiella spp (3%); Proteus spp (9%) | Not done |
Banapurmath C et al. 1994 [48] | 8.3% | Not specified | Escherichia coli (42.9%); Klebsiella spp (14.3%); Proteus spp (28.6%); Enterobacter spp (14.3%) | Not done |
Jeena PM et al. 1995 [36] | 37.5% | Not specified | Total gram negatives (79%); Escherichia coli (53%), | All gram-negatives; Nalidixic acid (100%), amikacin (100%), cephalexin (91%) and Augmentin® (94%), cotrimoxazole (58%), trimethoprim (69%) and ampicillin (86%) |
Caksen H et al. 2001 [47] | 14.8% | Not specified | Escherichia coli (27.7%); Klebsiella pneumoniae (61.1%); Staphylococcus aureus (5.6%); Enterobacter spp (5.6%) | Not done |
Bagga A et al. 2003 [4] | 15.2% | Moderate malnutrition: 7.3%; Severe malnutrition: 22.8%. Diarrhea: 23.3%; No diarrhea: 10.1% | Escherichia coli (64.7%); Klebsiella spp (23.5%); Proteus spp (5.9%); P aeruginosa (5.9%) | Most organisms sensitive to co-trimoxazole, amoxicillin, cephalexin, ciprofloxacin, gentamicin and ceftriaxone |
Gopal G and Premalatha R 2014 [49] | 11.3% | Males: 10.8%; Females: 12.2%. Grade II: 11.8%; Grade III: 16.4% and Grade IV malnutrition: 4.5% | Not done | Not done |