Urinary tract infection in febrile children under-5 years: Epidemiology and microbial profile from a tertiary care hospital setting

Background: Febrile illness in pediatric populations often poses a diagnostic challenge due to overlapping clinical features across various etiologies. While respiratory infections are common, urinary tract infections (UTIs) are significant contributors to morbidity, frequently complicated by increasing antimicrobial resistance. Aims and Objectives: This study aimed to determine the prevalence of UTI among children under 5 years old presenting with febrile illness, identify clinical and laboratory predictors of UTI, and describe the microbiological profile and drug resistance patterns of the isolates. Materials and Methods: A hospital-based cross-sectional study (June 2023–May 2024) was conducted, including febrile children aged 1 month–5 years from pediatric inpatient wards and the outpatient department. Fever was defined as axillary temperature ≥37.8°C at presentation or within 72 h. A clean catch midstream urine sample was collected for urine microscopy and culture. A colony count ≥105 colony-forming units/mL was significant and considered a UTI. Clinical and Laboratory Standards Institute guidelines were followed for antibiotic sensitivity testing, and data were analyzed using appropriate statistics, with ethical approval. Results: Out of 200 pediatric patients, respiratory tract infections were the most common diagnosis (26.5%), followed by culture-confirmed UTI (16%). Significant clinical predictors for UTI included a fever duration of ≥5 days (odds ratio [OR] =2.73; P=0.013) and patient location, with higher prevalence in the outpatient department (24.4%) versus the inpatient department (9.6%; P=0.019). The presence of ≥5 pus cells/high-power field was the strongest laboratory predictor, increasing UTI odds nearly six-fold (OR=5.80; P<0.001). Microbiologically, Gram-negative bacilli (68.75%), predominantly Escherichia coli (34.38%), were the leading pathogens. Notably, 81.82% of Gram-negative isolates were multidrug resistant, and 54.54% were extended-spectrum beta-lactamase producers. Conclusion: UTI is a frequent cause of pediatric febrile illness. Prolonged fever and pyuria are reliable indicators for screening. The high prevalence of multidrug-resistant uropathogens necessitates vigilant antimicrobial stewardship and routine urinary screening in febrile children.