Prevalence of urinary tract infection in febrile infants
Background: Urinary tract infection (UTI) is one of the most common bacterial infections in infancy, with a high risk of recurrence, and maybe an indicator of underlying urinary tract abnormality. It is often misdiagnosed due to irregular and unrelated symptomatology in the absence of directed screening. Objectives: The objectives of the study were to assess the feasibility of mid-stream clean catch method in infants for collecting a urine sample, compare the reliability of urinalysis in comparison with urine culture and to determine the prevalence of UTI among febrile infants in a rural setting. Materials and Methods: The study was conducted in a level-2 pediatric hospital involving 320 febrile infants attending the out-patient department from January 1, 2018, to June 30, 2018. Urine specimens were collected using midstream clean-catch urine (CCU) method and tested by urinalysis and culture. Results: Urine sample was successfully obtained by the CCU method in 320 (88.9%) out of 360 infants, of which only 8 (2.5%) showed contamination in culture. A total of 20 (6.25%) infants were culture positive for UTI. Only 14 (70%) of these showed positive urinalysis, while 17 (85%) of the culture-positive cases had a provisional diagnosis other than UTI. Further radiological examination revealed renal abnormalities in two out of six culture-positive infants who underwent subsequent studies. Conclusion: CCU method is reliable method for successful collection of urine and low contamination and can be used reliably in the absence of supra pubic aspiration/catheterization. Urinalysis lacks sensitivity in comparison with urine culture, necessitating the use of urine culture to diagnose/rule out UTI in infants. Culture-positive infants need to undergo a radiological examination to screen for abnormalities of the renal tract.