Published: 2021-11-23

Clinicoetiological profile of urinary tract infection in pediatric population in a teaching hospital in south India

Poornima Venugopal, Carol Sara Cherian, Pooja Raghunath


Background: Urinary tract infection (UTI) is one of the most common bacterial infections seen in children. A wide range of organisms with varying antibiotic sensitivity patterns have been known to cause UTI. The objective of the study was to analyse the clinical presentation of UTI in children between 1-month to15 years of age and to analyse the causative microorganism and their drug susceptibility in UTI in children between 1 month to 15 years of age.

Methods: A retrospective study was conducted in a teaching hospital in Kerala, between July 2018 and June 2020 among children 1 month to 15 years of age who presented with symptoms of UTI. Patients who had culture positive UTI were included in the study. Clinical data was obtained from inpatient and outpatient records. Antimicrobial susceptibility was done for positive urine culture by Kirby-Bauer disk diffusion method. Statistical analysis was done using Statistical package for social sciences (SPSS) software version 16.

Results: Of the 1057 urine samples analysed, 18.44% had significant bacteuria. 43.07% were children less than one year of age with male predominance. Fever and dysuria were the most common clinical presentation. E. coli was the most prevalent pathogen isolated followed by Klebsiella pneumoniae. Enterococcus faecalis was the only gram-positive bacilli isolated. Highest resistance was shown to ampicillin, third generation cephalosporins and co-trimoxazole. Least resistance was shown to nitrofurantoin, fluoroquinolones, aminoglycosides, piperacillin- tazobactam and carbapenems.

Conclusions: Regular surveillance programme is necessary for implementation of guidelines for empiric treatment of UTI.


Children, Urinary tract infection, Antibiotic susceptibility, Escherichia coli

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Amin EK, Zaid AM, Abd El Rahman IK, El-Gamasy MA. Incidence, risk factors and causative bacteria of urinary tract infections and their antimicrobial sensitivity patterns in toddlers and children: A report from two tertiary care hospitals. Saudi Journal of Kidney Diseases and Transplantation. 2020;31(1):200.

Shrestha LB, Baral R, Poudel P, Khanal B. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC pediatrics. 2019;19(1):1-8.

Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. The Pediatric infectious disease journal. 2008;27(4):302-8.

Downing H, Thomas-Jones E, Gal M, Waldron CA, Sterne J, Hollingworth W et al. The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC infectious diseases. 2012;12(1):1-15.

Desai DJ, Gilbert B, McBride CA. Paediatric urinary tract infections: Diagnosis and treatment. Australian family physician. 2016;45(8):558.

Benachinmardi K, Padmavathy M, Malini J, Navaneeth B. Microbiological profile and antibiogram of uropathogens in pediatric age group. International Journal of Health & Allied Sciences. 2015;4(1):61.

Shaikh N, Craig JC, Rovers MM, Da Dalt L, Gardikis S, Hoberman A et al. Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA pediatrics. 2014;168(10):893-900.

Yerega DA, Woldeamanuel Y, Yihenew G, Gize A. Bacterial profile and antibiotic susceptibility pattern of urinary tract infection among children attending Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. Infection and drug resistance. 2019;12:3575.

Gupta P, Mandal J, Krishnamurthy S, Barathi D, Pandit N. Profile of urinary tract infections in paediatric patients. The Indian journal of medical research. 2015;141(4):473.

Badhan R, Singh DV, Badhan LR, Kaur A. Evaluation of bacteriological profile and antibiotic sensitivity patterns in children with urinary tract infection: A prospective study from a tertiary care center. Indian journal of urology. 2016;32(1):50.

American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infections. Practice parameters: The diagnosis, treatment and evaluation of the initial urinary tract infections in febrile infants and young children. Pediatrics. 1999;103:843-52.

Chandrasekharam VV, Srinivas M, Charles AR, Agarwala S, Mitra DK, Bal CS, et al. Urinary-tract infection affects somatic growth in unilateral symptomatic hydronephrosis. Pediatr Surg Int. 2002;18:451-4.

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.

Ohanu ME. Etiology and Antimicrobial Susceptibility Pattern of Uropathogens in Children and Adolescents in a Tertiary Hospital: Moving from the Known to the Unknown. Archives of Clinical Microbiology. 2021;12(S1):141.

Baron EJ, Peterson LR, Finegold SM. 11th ed. St Louis: Mosby. Bailey and Scott's Diagnostic Microbiology. 2002;259-83.

CLSI. Clinical and laboratory Standards Institute. Document No M100. Performance Standards for Antimicrobial Susceptibility Testing. 29th ed. Wayne, PA: CLSI. 2020.

Mortazavi F, Shahin N. Changing patterns in sensitivity of bacterial uropathogens to antibiotics in children. Pak J Med Sci. 2009;25(5):801-5.

Msaki BP, Mshana SE, Hokororo A, Mazigo HD, Morona D. Prevalence and predictors of urinary tract infection and severe malaria among febrile children attending Makongoro health centre in Mwanza city, North-Western Tanzania. Arch Public Health. 2012;70(1):4.

Mava Y, Timothy SY, Zailani SB, Ambe JP. Significance of Pyuria in the diagnosis of urinary tract infection in children with sickle cell anaemia in Maiduguri, Nigeria. Afr J Clin Exp Microbiol. 2012;13(2):103-9.

Yismaw G, Asrat D, Woldeamanuel Y, Unakal CG. Urinary tract infection: bacterial etiologies, drug resistance profile and associated risk factors in diabetic patients attending Gondar University Hospital, Gondar, Ethiopia. Eur J Exp Biol. 2012;2(4):889-98.

Kaur N, Sharma S, Malhotra S, Madan P, Hans C. Urinary tract infection: aetiology and antimicrobial resistance pattern in infants from a tertiary care hospital in northern India. J Clin Diagn Res. 2014;8(10):DC01.

Parajuli NP, Maharjan P, Parajuli H, Joshi G, Paudel D, Sayami S, et al. High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal. Antimicrob Resist Infect Control. 2017;6:9.

Assefa A, Asrat D, Woldeamanuel Y, Abdella A, Melesse T. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia. Ethiop Med J. 2008;46(3):227-35.

Magliano E, Grazioli V, Deflorio L. Gender and age-dependent etiology of community-acquired urinary tract infections. Sci World J.

Song SN, Zhang BL, Wang WH, Zhang X. Spectrum and drug sensitivity of pathogenic bacteria in children with nephrotic syn drome complicated by urinary tract infection: an analysis of 97 cases]. Zhongguo Dang Dai Er Ke Za Zhi Chin J Contemp Pediatr. 2012;14(9):657-0.

Jitendranath A, Radhika R, Bhargavi L, Bhai G, Beevi R. Microbiological profile of urinary tract infection in pediatric population from a tertiary care hospital in South Kerala. J Bacteriol Mycol Open Access. 2015;1(1):4-7.

Sonkar L, Singh R, Ali I, Prakash V, Verma D. Antimicrobial susceptibility pattern of various etiological agents causing pediatric urinary tract infection. International Journal of Contemporary Medical Research. 2020;7(10):4-8.

Sharma A, Shrestha S, Upadhyay S, Rijal P. Clinical and bacteriological profile of urinary tract infection in children at Nepal Medical College Teaching Hospital. Nepal Medical College Journal. 2011;13:24-6.

GK Rai, HC Upreti, SK Rai, KP Shah, Shrestha RM. Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital-based study. Nepal Med Coll J. 2008;10:86-90.

Singh SD, Madhup SK. Clinical Profile and Antibiotics Sensitivity in Childhood Urinary Tract Infection at Dhulikhel Hospital. Kathmandu Univ Med J. 2013;44:319-24.

Ghadage DP, Nale SS, Kamble DS, Muley VA, Wankhade AB, Mali RJ et al. Study of aetiology and anti-biogram of uropathogens in children-a retrospective analysis. Journal of clinical and diagnostic research. 2014;8(1):20.

Ramagopal G. Clinical and Microbiological Profile of Children with Urinary Tract Infection. Journal of Pediatric Nephrology. 2018;6(2).

Pal N, Rit K, Naskar S, Kumar S, Guhathakurata R. A study of bacteriological and antibiotic susceptibility profile of pediatric urinary tract infection with special emphasis on extended spectrum beta-lactamase production in a tertiary care hospital of Eastern India. International Journal of Health.

Dash M, Padhi S, Mohanty I, Panda P, Parida B. Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India. J Family Community Med. 2013;20:20 6.

Mehta M, Bhardwaj S, Sharma J. Screening of urinary isolates for the prevalence and antimicrobial susceptibility of enterobacteria other than Escherichia coli. Int J Life Sci Pharma Res. 2013;3:100 4.

Chhetri PK, Rai SK, Pathak UN, Thapa JB, Devkota KC, Shrestha BO, et al. Retrospective study on urinary tract infection at Nepal Medical College Teaching Hospital, Kathmandu. Nepal Med Coll J. 2001;3:83 5.

Bays AG, Anadeto F. Clinical and Laboratory Profile of Urinary Tract Infection among Children at the Outpatient Clinic of a Tertiary Hospital. PIDSP Journal. 2010;11(1):10-6.

Taneja N, Chatterjee S, Singh M, Singh S, Sharma M. Pediatric urinary tract infections in a tertiary care centre from north India. Indian J Med Res. 2010;131:101-5.

AM Qureshi. Organisms Causing Urinary Tract Infection in Pediatric Patients at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad. 2005;17(1):72-4.

Vaidya SS. Study of clinical etiological and radiological profile of UTI cases. Int J Contemp Pediatr. 2018;5(4):1199-206.

Brkic S, Mustafic S, Nuhbegovic S, Ljuca F, Gavran L. Clinical and epidemiology characteristics of urinary tract infections in childhood. Med Arh. 2010;64:135-8.

Anis-ur-Rehman MJ, Siddiqui TS, Idris M. Frequency and clinical presentation of UTI among children of Hazara division. Pakistani Ayub Med Coll Abbottabad. 2008;20(1).

Rushton HC. Urinary tract infections in children: Epidemiology. Evaluation and management. Pediatr Clin North Am. 1997;44:1133-69.

Elpis M. Antimicrobial susceptibility of pediatric uropathogens in Thrace, Greece. Int Urol Nephrol. 2011;43:549-5.

Payel C, Narayan CS, Chitrita C. Etiology and drug resistance profile of pediatric urinary tract infections in Eastern India. Int Res J Medical Sci. 2014;2(6):11-3.