URINARY TRACT INFECTION IN FEBRILE UNDER-FIVE CHILDREN SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

URINARY TRACT INFECTION IN FEBRILE UNDER-FIVE CHILDREN SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

A prospective study of urinary tract infection (UTI) in 300 (152 males and 148 females) febrile
children aged less than 60 months (mean 25.4 months) seen at the University College Hospital
Ibadan was carried out between 15th July 2004- 23rd July 2005. This was to determine the
contribution of UTI to febrile illnesses, the bacterial pathogens, and their antimicrobial
sensitivity pattern. The study also sought to determine the prevalence of vesico-ureteric reflux
among the cohort of children with urinary tract infection. Urine was obtained either by
suprapubic aspiration or by midstream collection. All subjects had dipstick urinalysis and
their urine sediments were examined for pyuria, and bacteria. Nineteen (6.3 percent) of the 300
subjects had UTI. There were 9 males and 10 females. The gender difference in prevalence of
UTI was not significant. UTI was significantly more common in children with a history of
fever of at least 1 week at evaluation. (16.2% vs 4.9% p= 0.02) None of the 12 patients with
features suggestive of UTI had the disease. Positive leucocyte esterase (at least trace) and
pyuria had low sensitivity but high specificity for UTI. Positive leucocyte esterase had
sensitivity of 21.1%, specificity of 97.9%, positive predictive value of 40.0% and negative
predictive value of 94.8% for UTI. The corresponding values for pyuria were 36.8%, 97.9%,
53.8% and 97.1% respectively. Bacteria in the urine sediment had high sensitivity and
specificity for UTI. (Sensitivity 89.5%, specificity 95.7%, positive predictive value, 58.6% and
negative predictive value of 94.8%) Urinary isolates were Escherichia coli (n=6), Klebsiella
(n= 6), Staphlococcus aureus (n=3), β- haemolytic Streptococcus (n=2), Salmonella (n=1) and
Proteus (n=1). Over 70 percent of the isolates were sensitive to ceftriaxone, ciprofloxacin,
nitrofurantoin and cefuroxime. Most isolates were resistant to clavulanate potentiated
amoxicillin, amoxicillin, ampicillin and cotrimoxazole. Ceftriaxone, nitrofurantoin and
cefuroxime are advocated in the empiric treatment of UTI.

URINARY TRACT INFECTION IN FEBRILE UNDER-FIVE CHILDREN SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

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