Prevalence of urinary tract infection and the validity of urine analysis in the diagnosis of uti in febrile under-fives at Nnamdi Azikiwe University Teaching Hospital, Nnewi: a cross-sectional study.

backgroundUrinary tract infection (UTI) is a common cause of fever in febrile under-fives, but this is often overlooked due to the ambiguity of its presentation, especially in this malaria-endemic region. This makes clinical recognition difficult despite the potential risk of renal scarring and chronic kidney disease (CKD) later in life, if inappropriately treated. Additionally, urine culture, the gold standard for diagnosis, is limited by its time-consuming nature. Due to the wide variation in reports on the accuracy of the dipstick test as a rapid screening test for UTI in children, studies are necessary to validate its relevance in the diagnosis of UTI in different practice localities. This study evaluated the effectiveness of dipstick urinalysis in diagnosing UTIs in febrile children under five years old at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi.

methodsThree hundred thirty children aged 1 month to 59 months with an axillary temperature of ≥ 37.5 °C were recruited consecutively from July 2016 to April 2017 from the Children Outpatient (CHOP) and the Children Emergency Room (CHER). Sociodemographic and clinical data were collected using interviewer-administered questionnaires. Urine samples were collected from each participant for dipstick urinalysis, microscopy, and culture testing. Data were analysed using SPSS software version 21. The level of significance for tests of association was set at 5%.

resultsThere were 218 males and 112 females, resulting in a male-to-female ratio of 1.9:1. Subjects aged 1 to 11 months had the highest frequency, comprising 31.5% of the study population. The prevalence of UTI based on urine culture was 4.8% and it was significantly higher in females than in males. Temperature ≥ 38.4 °C had a significant association with the presence of UTI. No other clinical feature was significantly associated with UTI. Using urine culture as the gold standard, the sensitivities of Leucocyte esterase (LE), nitrite, and their combination (LE and/or nitrite) were 31.3%, 25% and 37.5% respectively, while their specificities were 97.1%, 100% and 97.1% respectively. Gram stain of uncentrifuged urine had the best accuracy of the individual tests studied. E. coli was the commonest pathogen, which was isolated in 43.8% of children with UTI, while meropenem, cefepime, and ceftazidime had the highest antimicrobial activity.

conclusionUTI is common in febrile under-fives, and dipstick urinalysis is a good screening test, recommended for routine use in this population. E. coli is the commonest organism responsible for UTI in febrile under-fives in NAUTH, Nnewi, followed by Klebsiella spp. All isolated organisms were sensitive to Meropenem, while Cefepime and Ceftazidime also had high antimicrobial activities and should be used in the empirical treatment of the disease.