Vol. 8, Issue 2, Part A (2025)

Background: Urinary tract infections (UTIs) are common across infancy and early childhood, ranking second only to respiratory tract infections in terms of bacterial morbidity. In young children, especially those under two years, it is clinically challenging to differentiate between cystitis and pyelonephritis due to overlapping symptoms such as fever. 
Aim of the Study: This study aims to determine the prevalence of UTI in febrile children under the age of five years.
Patients and Methods: A descriptive observational study was conducted at Babylon Maternity and Children Teaching Hospital from July 15 to December 31, 2012. A total of 300 febrile children aged 1 to 5 years, all with temperatures exceeding 38.0°C, were included. Each patient underwent clinical examination and relevant investigations based on the fever's associated features. Out of these, 102 children with an unclear source of fever were further evaluated for UTI using microscopic urinalysis, dipstick testing, and urine culture, the latter serving as the gold standard for diagnosis.
Results: UTI was confirmed by urine culture in 14 children (13.4%): 10 females (18.5%) and 4 males (8.3%), yielding a female-to-male ratio of 2.5:1. Pyuria was observed in 25 children, 10 of whom had positive cultures (71.4%). Leukocyte esterase was positive in 17 cases with 12 confirmed UTIs (85.7%), while nitrite was positive in 18 cases, 9 of whom had UTIs (64.3%). When pyuria and dipstick tests were combined, sensitivity and negative predictive value were both 100%, with specificity at 79.5% and positive predictive value at 43%. E. coli was the most common organism (64.3%), followed by Proteus and Enterococcus (14.3% each), and Klebsiella (7.15%).
Conclusions: UTI prevalence in febrile children under five was 13.7%, with a predominance in females. Combined testing methods (microscopy and dipstick) proved highly effective for UTI prediction. E. coli was the leading causative agent.