Background: Asymptomatic bacteriuria (ASB) is a common but often missed condition in school-aged children affected children remain asymptomatic, persistent bacteriuria may predispose high-risk groups to recurrent urinary tract infections and renal complications and the data regarding the prevalence and associated factors of ASB among Iraqi school-aged children are limited.
Aim of the study: To determine the prevalence of asymptomatic bacteriuria among school-aged children and to identify factors associated with its occurrence.
Patients and methods: Prospective cross-sectional screening study was conducted at Karbala Health Directorate primary health care centers from July to December 2025 and included total of 194 school-aged children (6–14 years) attending the primary care. Children with urinary symptoms, recent antibiotic use, or known urinary tract abnormalities were excluded. Data were collected using a questionnaire that included clinical assessment, urinalysis, urine culture, and relevant laboratory investigations. Asymptomatic bacteriuria was defined as significant bacterial growth on urine culture in the absence of urinary symptoms.
Results: The prevalence of asymptomatic bacteriuria was 6.7% (13/194). Escherichia coli was the most commonly isolated organism (62%), followed by Klebsiella, Proteus, and Enterococcus species. Pus cells, positive nitrite test, and bacteriuria on microscopy were significantly more common among children with ASB (p<0.05). Female gender, low daily water intake, and infrequent sanitary pad changes among menstruating girls were significantly associated with ASB. No significant differences were seen between ASB-positive and ASB-negative children regarding hemoglobin level, white blood cell count, serum creatinine, or blood urea. Nitrofurantoin showed the highest antimicrobial sensitivity among isolated organisms.
Conclusions: Asymptomatic bacteriuria is relatively common among school-aged children, particularly girls. Escherichia coli is the predominant causative organism. ASB is associated with modifiable factors such as inadequate hydration and poor menstrual hygiene.
Recommendations: Consider targeted screening of high-risk groups, especially school-aged girls. Health education programs should focus on adequate water intake and proper menstrual hygiene for girls.