Clinical profile of pediatric patients with urinary tract infection in a tertiary care centre in Kashmir, India

Khalid Kawoosa, Rahid Rasool Malla, Sheeraz Ahmad Dar, Syed Heena Kubravi


Background: The urinary tract is a common site of infection in pediatric patients. Author studied the clinical and microbiological profile along with the antibiotic resistance in children with UTI attending centre.

Methods: It was a prospective study was conducted in the Department of Pediatrics, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India over a period of one year from August 2017 to August 2018.

A total of 250 children aged 1-36 months were included in the study. A proper history and examination were done in each case. A clean catch mid-stream urine sample was obtained from each child. Quantitative microscopy and urine culture were performed. Standard biochemical tests were done to identify the isolates and for determination of antibiotic sensitivity.

Results: Out of the 250 children studied , a total of 216 children were diagnosed as UTI by positive urine culture.102 were males and 114 were females. Significant pyuria was detected in 85%patients. Fever with irritability was the most common presenting symptom (71%) followed by vomiting (63%) and abdominal pain (52%).The most common uropathogen detected was E. coli (57%) followed by Klebsiella spp. (20%), proteus (16%), pseudomonas (5%), and candida (2%). Majority of the patients responded to treatment with ceftriaxone followed by cefixime. Antibiotic resistance in vitro was least seen with amikacin (25%) followed by nitrofurantoin (11%). 91.3% of UTI detected was nosocomial. Vesicoureteral reflux was found in 49% of patients while 13% were diagnosed with posterior urethral valve.

Conclusions: Urinary tract infection should be considered as one of the most important differential diagnosis in patients with fever attending pediatric OPD. Urine microscopy and culture should be a part of routine diagnostic evaluation in all febrile children. Early treatment of UTI is important to prevent later sequelae including pyelonephritis and renal scarring.


Escherichia coli, Klebsiella spp., Posterior urethral valve, Urinary tract infection, Uropathogen, Vesicoureteral reflux

Full Text:



Benador D, Benador N, Slosman D. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet. 1997;349(9044):17-9.

Smellie JM, Prescod NP, Shaw PJ, Risdon RA, Bryant TN. Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults. Pediatric Nephrol. 1998;12(9):727-36.

Pylkkanen J, Vilska J, Koskimies O. The value of level diagnosis of childhood urinary tract infection in predicting renal injury. Acta Paediatr Scand. 1981;70(6):879-83.

Stokland E, Hellstrom M, Jacobsson B. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr. 1996;129(6):815-20.

Narasimhan KL, Chowdhary SK, Kaur B, Mittal BR, Bhattacharya A. Factors affecting renal scarring in posterior urethral valves. J Pediatr Urol. 2006;2: 569-74.

Narasimhan KL, Mahajan JK, Kaur B, Mittal BR, Bhattacharya A. The vesicoureteral reflux dysplasia syndrome in patients with posterior urethral valves. J Urol. 2005;174:1433-5.

American Academy of Pediatrics Committee on Quality Improvement, Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999;103(4): 843-52.

Smellie JM, Hodson CJ, Edwards D. Clinical and radiological features of urinary infection in childhood. BMJ. 1964;5419:1222-6.

Yamamoto S, Tsukamoto T, Terai A. Genetic evidence supporting the fecal-perinealurethral hypothesis in cystitis caused by Escherichia coli. J Urol. 1997;157(3):1127-9.

Cox CE, Hinman F. Experiments with induced bacteriuria, vesical emptying and bacterial growth on the mechanism of bladder defense to infection. J Urol. 1961;86:739-48.

Subcommittee on urinary tract infection and steering committee on quality improvement and management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595-610.

Malhotra SM, Kennedy II WA. Urinary tract infections in children: treatment. Urol Clin North Am. 2004;31(3):527-34.

Hoberman A, Wald ER, Hickey RW. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics. 1999;104(1):79-86.

Smellie JM, Ransley PG, Normand IC. Development of new renal scars: a collaborative study. Brit Med J (Clin Res Ed). 1985;290(6486):1957-60.

Koyle MA, Barqavi A, Wild J. Pediatric urinary tract infection: the role of fluoroquinolones. Pediatric Infect Dis J. 2003:22(12):1133-7.

Jahnukainen T, Chen M, Celsi G. Mechanisms of renal damage owing to infection. Pediatr Nephron. 2005;20(8):1043-53.

Jacobson SH, Eklof O, Eriksson CG. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ. 1989;299(6701):703-6.

Gill DG, Costa B, Cameron JS. Analysis of 100 children with severe and persistent hypertension. Arch Dis Child. 1976;51(12):951-6.