Prevalence of urinary tract infections in febrile children less than five years of age: a chart review

Abstract

Background: In children less than five years of age, fever is the most common reason to visit emergency/outpatient pediatric departments. Quite often, the child receives antibiotics empirically, without adequate evaluation for urinary tract infection. The objectives of this study were to evaluate the prevalence of urinary tract infection (UTI) in febrile children, less than 59 months of age.

Methods: Records of 370 children between 1 to 59 months of age, attending the department of paediatrics with febrile illness were reviewed. Data related to age, gender, socioeconomic status, nutritional status, clinical diagnosis, abdominal ultrasound, urinary microscopy and urine culture were analysed.

Results: Records of 370 children were evaluated, among them, 240/370 (64.86%) children were below two years, and 130/370 (35.13%) were above two years. 165/370 (44.6%) were males, and 205/370 (55.4%) were females. The overall occurrence of urinary tract infection as defined by significant pyuria was 48/370 (12.9%) in children less than five years of age. The prevalence of UTI in children less than one year of age was 26/370 (7%), whereas it was 15/370 (4 %) in less than two years of age and 7/370 (1.8%) between two to five years. Among pyuric patients, 13/48 (27%) had a urine culture positive reports. The positive urine culture was seen in 6/13 (46%) of children with pus cells> 5/HPF and remaining 7/13 (54%) in children with pus cells >10/HPF. E. coli was the predominantly [9/13 (69%)] seen organism in urine cultures.

Conclusions: In present study, the overall occurrence of UTI in children less than five years was 13%. Only 3.5% of children had culture-positive UTI. 46% of positive cultures were found in children having urine pus cells > five /HPF in the centrifuged sample, it is recommendable that children with pyuria should be evaluated thoroughly to initiate prompt treatment and have a successful outcome.