Study of culture and sensitivity pattern of urinary tract infection in febrile preschool children in a tertiary care hospital

Abstract

Background: Urinary tract infection (UTI) is the most common bacterial illness among febrile infants and young children, with a reported prevalence between 4.1% and 7.5%. Most infections remain undiagnosed if tests are not routinely performed to detect them. Methods: The present study was carried out in G Kuppuswamy Naidu Memorial hospital, over a period of one year. Five hundred febrile children between the ages of 3 years to 6 years with fever who attended pediatric outpatient department formed the study group. Detailed history was taken and clinical examination was done in all the cases to find out the cause of fever with special emphasis given to symptoms of UTI. Results: Five hundred febrile children between the ages of 3 years to 6 years with fever who attended pediatric outpatient department formed the study group. Out of 500 children’s, 20 cases were diagnosed to have UTI as judged by the presence of significant bacterial growth in urine culture. There was slight female preponderance in culture positive cases with male to female ratio of 1:1.50. In culture positive cases, 12 (60%) patients had bacteria in their urine where as in culture negative cases only 5 (1.04%) patients had bacteriuria which was statistically significant. However, 8 (40%) cases with UTI would have been missed if only presence of bacteria on microscopy was taken as a method of diagnosis for UTI. In diagnosing UTI, pyuria >10 WBC/HPF was more specific with higher positive predictive value than the conventional >5 WBC/HPF. Bacteriuria occurring along with pyuria had a specificity of 98.3% in predicting infection. The most common organism isolated from patients with UTI was E.coli followed by klebsiella. Conclusions: Urinary tract infection should be considered as a potential cause of fever in children below six years of age. As the febrile children with UTI usually present with nonspecific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation.