Prevalence of urinary tract infection among preschool febrile children attending the pediatric OPD
Keywords:Febrile children, Urine culture, Urinary tract Infection
Background: Urinary tract infection (UTI) is one of the most common bacterial illness among febrile infants and preschool children with a reported prevalence between 4.1% and 7.5%. The objective of this study was to know the prevalence of urinary tract infection in preschool febrile children.
Methods: Cross sectional study conducted in pediatric OPD of a Government teaching hospital with 500 febrile preschool children aged 3 to 6 years.
Results: Prevalence of UTI in febrile preschool children aged 3-6 years was 2.9% in males and 5.5% in females with overall prevalence of 4%. 15% had temperature > 39.3 oC. 45% had dysuria, 35% had vomiting. 25% and 20% had increased frequency and burning micturition respectively. 70% patients with UTI and 30% cases without UTI had proteinuria. 95% patients had pus cells > 5 per HPF. 60% patients had bacteria in their urine where as in culture negative cases only 1.04% had bacteria. E coli was the common organism isolated (80%), followed by Klebsiella. Majority were resistant to Ampicillin (55%). 75% of microorganisms were sensitive to ceftriaxone. 70% were sensitive to gentamycin, norfloxacin and cephalexin. 5% UTI cases had RFT. KUB X-ray was normal in all the cases. 20% of cases showed features suggestive of acute pyelonephritis on Ultrasonography. 1 out of 4 Patients who underwent Intravenous pyelography showed hydronephrosis. 2 out of 4 cases showed VUR in MCU.
Conclusions: UTI is a potential cause of fever in children below 6 years of age. Urine culture is the gold standard for diagnosis of UTI in children. Parents should be educated about the importance of UTI and its long-term complications.
Hoberman A, Chao HP, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123:17-23.
Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M. Pyuria an bacteriuria in urine specimens obtained by catheter from young children with fever. J Pediatr. 1994;124:35-9.
Fallanzadeh MH, Alamdarbe HM. Prevalance of urinary tract infection in preschool febrile children. Irn J Med Sci. 1999;24:35-9.
Shaw KN, Gorelick M, McGowan KL, Yaksoe HM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department pediatrics. 1998;102:E16.
Alper BS, Cirry SH. Urinary tract infection in children. Am Fam Physician. 1005;72:2483-8.
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.
Smillie JM. Poulton A, Prescond NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ. 1994;308:1193-6.
Kramer MS, Tange SM, Drummond KN, Mills EL. Urinary testing in young febrile children: a risk benefit analysis. J Pediatr. 1994;125:6-13.
Hoberman A. Enhanced urinalysis as a screening test for urinary tract infection. Pediatr. 1991;91:1197-9.
Matthai J, Ramasway M, Urinalysis tract infection. Indian J Pediatr. 1995;62:713-6.
Lohr JA, Portilla MG, Gender TG, Dunn ML, Dudley SM. Making a presumptive diagnosis of urinary tract infection by using a urinalysis performed in an on-site laboratory. J Pediatr. 1993;122:22-5.
Barchner H, Philipp B, Darhgsky B. Prevalance of bacteriuria in febrile children. Pediatr Infect Dis J. 1987;6(3):239-42.
Sood S, Upadhyaya P, Kapil A, Lodha R, Jain Y, Bagga A. An indigenously developed nitrite kit to Aid in the diagnosis of urinary tract infection. India Pediatr. 1999;36:887-90.
Crain EF, Gershel JC. Urinary tract infection in febrile younger than 8 weeks of age. Pediatr. 1990;86:363-7.
Dharnidharka VR, Kandoth PW. Prevalence of bacteriuria in febrile infants. Indian Pediatr. 2993;30:987-90.
Dharnidharka VR. Prevalence of bacteriuria in febrile children. Bom Hosp J. 1993;35:187-90.
Craig JC, Knight JF, Swushkanar P, Mantz E, Roy LP. Effect of circumcision on incidence of urinary tract infection in preschool boys. J Pediatr. 1996;128:23-7.
Wiswell TE, Roscelli JD. Corroborative evidence for the decreased incidence of urinary tract infectious in circumcised male infants. Pediatr. 1986;78:96-9.
Roberts KB, Charney E, Swerun RJ, Ahokhai VI, Bergman DA, Coulter MD. Urinary tract infection in infants with unexplained fever: a collaborative study. J Pediatr. 1983;103:864-7.
Buys H, Pead L, Hallett R. Supropubic aspiration under ultrasound guidance in children with fever of undiagnosed cause. BMJ. 1994;308:690-2.
Goldsmith BM, Campos JM. Comparison of urine dipstick, microscopy and culture for the diction of bacteriuria in children. Clin Pediatr. 1990;29:214-8.
Blane CE, Dipietro MA, Zerin JM, Aileen B, Bloom DA. Renal sonography is of a reliable screening examination for vesicoureteral reflux. J Pediatr. 1993;150:752-5.
Andrich MP, Majid M. Diagnostic imaging in the evaluation of the first urinary tract infection in infants and young children. Pediatr. 1992;90:436-41.
Bonadio WA. Prevalence of urinary tract infection in febrile infants. Pediatr Emerg Care. 1987;3:75-8.
Srivarus PR, Rath B, Prakash SK, Talukdar B. Usefulness of screening febrile infants for urinary tract infection. Indian Pediatr. 1996:33:218-20.
Rmakrishnan K. Prevalence of urinary tract infection in febrile convulsions. Indian J Pediatr. 1982;49:367-9.
Lee P, Jones KV. Urinary tract infections in febrile convulsions. Arch Dis Child. 1991;66:1287-90.
Jaya G. Evaluation of urinary tract infections. Indian Pediatr. 1996;33:635-40.
Shaw KM, Goreticle M, McGowan KL, Schwartz JS. Prevalance of urinary tract infection in febrile young children in the emergency department. Pediatr. 1998;102:E16.
Kenney IJ, Arthur RJ, Sweeney LE, Henry MA. Initial investigation of childhood urinary tract infection: does the plain abdominal x-ray still have a role? Br J Radiol. 1991;64:1007-9.
Alam US, Ganapathy S. Should renal ultrasonography be bone routinely in children with first urinary tract infection? Clin Pediatr. 1999;38:21-5.
Kangarloo H, Gold RH, Fine RH. Diament MJ, Bocchat MI. Urinary tract infection in infants and children evaluated by ultrasound. Radiol. 1985;154:367-73.
Gleeson FV, Gordon I. Imaging in urinary tract infection. Arch Dis Child. 1991;61:1282-3.