Study of prevalence of urinary tract infection in febrile children less than 5 years of age

Madhubalan T., Chidambaranathan S., Yazhini E.


Background: Fever is the most common reason for children under 5 years of age to visit the OPD. Unlike other foci of infection, only a little attention has been focused on the identification of UTI in febrile children. Quite often child receives antibiotics empirically without adequate evaluation of UTI. To determine the prevalence of UTI in all febrile children, from 2 months to 5years of age.

Methods: The study included children admitted with bronchiolitis in between during the period of December 2018 to March 2019 at Department of Pediatrics, Raja Muthiah Medical College and Hospital. Totally 200 consecutive children from 2 months to 5 years admitted in the pediatric department Data related to age, sex, predisposing factors will be noted. Urine analysis and urine culture have to be done in all these patients. USG abdomen to be done in patients with culture positive UTI.

Results: Among the 200 cases, the prevalence of UTI was higher among females (10%) than males (8%). Among the culture-positive cases UTI, an underlying focus of infection was present in 89% of cases and only 11% of cases did not have any foci. In this study, the % of cases with a duration of fever more than 5 days was 57, as compared to 43% in patients with fever less than 5 days. Among the 19 UTI cases, 5 of them presented with voiding difficulties and all the 5 cases had significant growth on culture. There was a significant association between UTI cases and voiding difficulties.

Conclusions: Hence through this study, authors concluded that pyuria of >5 pus cells /HPF in the centrifuged sample should be considered as significant pyuria and hence further evaluation should be done in all these cases to promptly initiate antibiotic treatment and also to prevent morbidity and several long term sequelae.


Prevalence, Pyuria, Significant growth, Urinary tract infection

Full Text:



Andrew Dziewit J. Urinary tract infection in febrile infants younger than 60 days of age. Penn Sci. 2002;1.

Bagga A, Sharma J. Urinary tract infections clinical features, evaluation, and treatment. Pediatr Today. 2000;3:395-401.

Bauchner H, Philipp B, Dahefsky B, Klein JO, Prevalence of bacteriuria, in febrile children. Pediatr Infect Dis. 1987;6:239-42.

Benador D, Benador N, Slosman DO, Nusslé D, Mermillod B, Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatr. 1994 Jan 1;124(1):17-20.

Berg UB. Long-term followup of renal morphology and function in children with recurrent pyelonephritis. J Urol. 1992 Nov;148(5 Part 2):1715-20.

Bryan CS, Reynolds KL. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol. 1984 Sep;132(3):494-7.

Hewitt IK, Zucchetta P, Rigon L, Maschio F, Molinari PP, Tomasi L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials. Pediatrics. 2008 Sep 1;122(3):486-90.

Cohen M. Urinary tract infections in children: 1 Female aged 2 Through 14, first two infections. Pediatrics. 1972;50:271-8.

Conway JJ, Cohn RA. Evolving role of nuclear medicine for the diagnosis and management of urinary tract infection. J Pediatr. 1994 Jan;124(1):87-90.

Dharnidharka VR, Kandoth PW. Prevalence of bacteriuria in febrile infants. Ind Pediatr. 1993 Aug 1;30(8):987-9.

Fallahzadeh MH, Alamdarlu HM. Prevalence of urinary tract infection in preschool febrile children. Irn J Med Sci. 1999;24:35-9.

Fowler JE, Stamey TA. Studies of introital colonization in women with recurrent urinary infections. VII. The role of bacterial adherence. J Urol. 1977 Apr;117(4):472-6.

Goldsmith BM, Campos JM. Comparison of urine dipstick, microscopy, and culture for the detection of bacteriuria in children. Clin Pediatr. 1990 Apr;29(4):214-8.

Hinman F. Mechanisms for the entry of bacteria and the establishment of urinary infection in female children. J Urol. 1966 Oct;96(4):546-50.

Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993 Jul 1;123(1):17-23.

Hovelius B, Mårdh PA. Staphylococcus saprophyticus as a common cause of urinary tract infections. Rev Infec Dis. 1984 May 1;6(3):328-37.

Hughes C, Hacker J, Roberts A, Goebel W. Hemolysin production as a virulence marker in symptomatic and asymptomatic urinary tract infections caused by Escherichia coli. Infec Immun. 1983 Feb 1;39(2):546-51.

Elder JS. Urologic disorders in infants and children. Richard EB ehrman, Kleigman RM, Jenson HB, eds. Nelson textbook of. Pediatrics, Harcourt and Saunders; 2000:1621-2.

Jacobson SH, Eklöf O, Eriksson CG, Lins LE, Tidgren B, Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. Bri Med J. 1989 Sep 16;299(6701):703-6.

Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin Nort Am. 1987;1:713.