A study of urinary tract infection in children aged 1-5 years admitted with acute febrile illness


  • Abdus Subhan Sohail Department of Paediatrics, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, Karnataka, India https://orcid.org/0000-0002-5842-9868
  • Pushpalatha K. Department of Paediatrics, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, Karnataka, India
  • Uday Kumar S. Department of Paediatrics, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, Karnataka, India
  • Kushal Kumar Department of Paediatrics, ESIC Medical College and PGIMSR, Rajajinagar, Bangalore, Karnataka, India




UTI, Febrile illness, Pyuria, Urine culture


Background: Urinary tract infection (UTI) is a common problem in pediatric age group and is a significant risk factor for long term sequelae. The clinical signs and symptoms of UTI are nonspecific in the first 5 years of age.

Methods: A cross-sectional study was conducted after obtaining institutional ethical clearance and informed consent from the parents, on 350 children aged 1 to 5 years admitted in with acute febrile illness.

Results: Out of 350 children with acute febrile illness 23 had culture proved UTI. The frequency of occurrence of UTI was 6.5%. Majority 8 (34.7%) of children with UTI were between 1-2 yrs. There was female preponderance with male: female ratio of 1:2.3. Twelve children with UTI belonged to lower socioeconomic status. Fourteen (60.87%) had nonspecific symptoms. Seventeen (73.9%) children had a provisional diagnosis other than UTI. pyuria >10 WBC/HPF had higher specificity (98.5%) and positive predictive value (72.2%) than >5WBC/HPF. Combined bacteruria and pyuria had specificity of 98.8 %. The most common organism isolated from children with UTI was E. coli, most of the organisms (73.9%) were sensitive to ceftriaxone. Abnormal ultrasonographic features was found in 17.4 % of children with UTI.

Conclusions: As the febrile children with UTI usually present with nonspecific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation. Urine culture is the gold standard for diagnosis of UTI. However combined bacteruria and pyuria had specificity of 98.8% and can be used to start empirical antibiotic therapy awaiting culture reports.



Wolff O, Maclennan C. Evidence behind the WHO guidelines: hospital care for children: what is the appropriate empiric antibiotic therapy in uncomplicated urinary tract infections in children in developing countries J Trop Pediatr. 2007;53(3):150-52.

Alper BS, Cirry SH. Urinary tract infection in children. Am Fam Physician. 2005;72(12):2483-88.

American academy of pediatrics, committee on quality improvement, subcommittee on urinary tract infection. The diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr. 1959;103:843-52.

Smellie JM, Poulton A, Prescond NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ. 1994;308:1193-6.

Pankaj Hari, RN Srivastava. Urinary tract infections. In: RN Srivastava, Arvind Bagga. Pediatric Nephrology,5th edn., New Delhi, Jaypee Brothers. 2011;273-87.

Rushton HG, Majd M, Jantausch B, Wiedermann BL, Belman AB. Renal scarring following reflux and non-reflux pyelonephritis in children: evaluation with 99m technetium-dimercaptosuccinic acid scintigraphy. J Urol. 1992;147(5):1327-32.

Wani KA, Ashraf M, Bhat JA, Parry NA, Shaheen L, Bhat SA. Paediatric urinary tract infection: a hospital-based experience. JCDR. 2016;10(10):SC04-7.

Rongala RP, Konkay KP, Naik R, Jaddu SR, Kakara RK. Frequency of urinary tract infection in febrile children of one to five years of age. Int J Pediatr Res. 2016;3(8):610-17.

Saheb SA. Prevalence of urinary tract infections in febrile children less than five years of age: a chart review. Int J Contemp Pediatr 2018;5(2):359-62.

Masika WG, O'Meara WP, Holland TL. Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya. Armstrong J. 2017;12(3):e0174199.

Shetty PN, Prashanth S, Jagadeeshwara S. Prevalence of urinary tract infection among preschool febrile children attending the pediatric OPD. Int J Contemp Pediatr. 2017;4(2):561-7.

Dharnidharka VR. Prevalence of bacteriuria in febrile children. Bom Hosp J. 1993;35:187-90.

Matthai J, Ramasway M. Urinalysis in urinary tract infection. Indian J Pediatr. 1995;62:713-6.

Madhubalan T, Chidambaranathan S, Yazhini E. Study of prevalence of urinary tract infection in febrile children less than 5 years of age. Int J Contemp Pediatr. 2020;7:xxx-xx.

Mod HK, Jeeyani HN, Shah BM. Urinary tract infection in children: clinical aspects and utility of urine dipstick test. Int J Contemp Pediatr. 2017;4:790-5.

Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M. Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever. J Pediatr. 1994;124:513-9.

Vaidya SS, Gaikwad SY. Study of clinical etiological and radiological profile of UTI cases. Int J Contemp Pediatr. 2018;5:1199-206.






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