Abstract:

Background: Urinary tract infection is the second commonest bacterial infection in children after respiratory tract infections. UTI is a significant cause of morbidity in pediatric population; early diagnosis and appropriate treatment is essential in order to avoid long term complications. 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 the treatment options and sensitivity of diagnostic tests.

Material and methods: a cross-sectional hospital based study was carried out from October 2010 to February 2011. Febrile children were serially recruited, demographic and clinical data were collected using standardized data collection tool. Urine culture on standard media was done using in house biochemical tests and susceptibility to common antibiotics done using the diffusion testing.

Results: A total of 370 children were recruited of whom 194 (52%) and 176(48%) were male and female respectively. The mean age was 25 months and 230 (62%) of children were below 25 months of age. The prevalence of UTI by culture, WBC urine microscopy, nitrite test and leucocytes esterase test was 39.7%, 25.6%, 10%, 4% respectively (p<0.05), 89 (50.6%) of female children had positive urine culture compared to 58(29.9%) of male children (p=0.001). positive urine culture was strong predicted by positive WBC microscopy, positive leukocyte esterase test and nitrite test (p<0.001).in the diagnosis of UTI using culture as gold standard the sensitivity of urine WBC microscopy was 44.2% leucocyte esterase 8.8% and nitrite 21.7%. The specificity of urine WBC microscopy was 86.5%, leucocytes esterase 99.1% and nitrite 97%. Escherichia coli (64 isolates) and Klebsiella pneumoniae (52 isolates). Resistance rates of Escherichia coli were ampicillin (98.4%), cotrimoxazole (94.3%), Augmentin nitrofurantoin (12.5%), ciprofloxacin (11.6%), Ceftazidime (11%) and cefepime (3.1%). Resistance rates of Klebsiella Pneumoniae were ampicillin (100%), cotrimoxazole (94.2%), Augmentin (86.5%), cephalexin (63.5%), cefaclor (55.8%) gentamicin (38.5%), ceftriaxone (46%), nitrofurantoin (21%), ciprofloxacin (19.2%) ceftraxidine (33%) and cefepime (21%). Staphylococcus aureus were 100% resistant to cephalexin, cefaclor, ampicillin and 75% resistant to augmentin and amoxicillin.

Conclusion and Recommendation: UTI is common among febrile children attending Bugando Medical Centre with prevalence of 39.7%. Escherichia coli and Klebsiella preumoniae are leading causes of UTI and are resistant to common used antibiotics, this pose challenges in treatment options of UTI in our setting. Positive urine culture was strongly predicted by positive WBC urine microscopy, positive leucocyte esterase and positive nitrite test. Urine dip stick has low sensitivity in the diagnosis of UTI in our setting. Routine urine culture and susceptibility pattern is recommended in all febrile children suspected of having UTI.