Abstract

Background: UTI is an important cause of morbidity in pediatric population; early diagnosis and appropriate treatment is essential in order to avoid long term com-plications. Therefore this study was done to estimate the magnitude of UTI among febrile children attending Bugando Medical Centre and also to provide the insight on treatment options and sensitivity of diagnostic tests.

Methods and Findings: A crossectional study was conducted from October 2010 to February 2011. Febrile children were serially recruited; demographic and clinical data were collected using standardized data collection tool. Urine culture, urine WBC microscopy and dipstick urinalysis were done followed by identification of isolates using in house biochemical tests and susceptibility to commonly used antibiotics was performed using the disc diffusion method. A total of 370 children were recruited of whom 194 (52%) were male. The median age was 18 (range 2-60) months. The prevalence of UTI by culture was 39.7%. On multivariate logistic regres-sion analysis positive urine culture was strongly predicted by age below 2 years (OR 2, p=0.008), female sex (OR 2.6, p<0.001), positive WBC microscopy (OR 4.9, p<0.001), positive nitrite test (OR 11.5, p<0.001). Clinical characteristics that predict positive UTI were diarrhea (OR 2.3, p=0.001) and prolonged fever for more than 5 days (OR 1.6, p=0.04). The sensitivity of urine WBC microscopy, leukocyte esterase and nitrite test in diagnosing UTI using culture as a gold standard was 44.2%, 8.8% and 21.7% with specificity of 86.5%, 99.1% and 97% respectively. Escherichia coli (64/147) and
Klebsiella pneumoniae (52/147) were the most common isolates. Resistance rates of
Escherichia coli were ampicillin (98.4%), co-trimoxazole (95.3%), amoxicillin/clavulanic acid (87.5%), cephalexin (61%), cefaclor (43.8%), gentamicin (21.9%), ceftriaxone (14%), nitrofurantoin (12.5%), ciprofloxacin (11.6%), ceftazidime (11%) and cefepime (3.1%). Higher resistance rates were observed in Klebsiella pneumoniae than Escherichia coli isolates.

Conclusion: UTI is common among febrile children attending Bugando Medical Centre. Majority of the isolates were resistant to commonly used antibiotics, this poses challenges in treatment options of UTI in our setting. Due to low sensitivity of dipstick urinalysis routine urine culture and susceptibility pattern is recommended in all febrile children suspected with UTI