Bacterial Urinary Tract Infections and Associated Factors, Bacterial Isolates and Antibacterial Susceptibility Patterns Among Febrile Children Under Five Years Attending Mbale Regional Referral Hospital
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Date
2026-09-16
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Busitema Universty
Abstract
Background: Fever is a common presentation among children under five years, and urinary tract infection is an important diagnosis to consider because clinical features may be nonspecific in young children. Local bacterial isolate and antibacterial susceptibility data are also important for guiding treatment. This study assessed bacterial urinary tract infections, associated factors, bacterial isolates and antibacterial susceptibility patterns among febrile children aged 2 to 59 months attending Mbale Regional Referral Hospital.
Methodology: A hospital based cross sectional study was conducted among 328 febrile children aged 2 to 59 months at Mbale Regional Referral Hospital. Data were collected using a structured questionnaire and clinical assessment. Urine specimens were obtained by sterile in and out catheterisation or clean catch midstream collection. Urine culture was used to identify significant bacterial growth, isolates were identified using standard microbiological procedures, and antibacterial susceptibility testing was performed using the Kirby Bauer disk diffusion method with Clinical and Laboratory Standards Institute, CLSI interpretive criteria. Modified Poisson regression was used to identify factors associated with bacterial urinary tract infection, UTI.
Results: Ninety of the 328 participants had culture confirmed bacterial UTI, giving a prevalence of 27.4%. Uncircumcised male children were 2.1 more likely to have bacterial UTI compared to the circumcised children, (adjusted Prevalence Ratio, aPR 2.1, 95% Confidence interval, CI 1.022 - 4.396, p = 0.044). 97 bacterial isolates were identified from 90 febrile children with 7 children having duo isolates. Escherichia coli was the most frequently identified isolate, 25.8%, followed by Klebsiella pneumoniae, 16.5%. Susceptibility was generally higher to imipenem, amikacin, gentamicin, fosfomycin, nitrofurantoin and piperacillin tazobactam, while lower susceptibility was observed for several commonly used agents including ampicillin and trimethoprim sulfamethoxazole.
Conclusion: Culture confirmed bacterial UTI was identified nearly 1 in 3 febrile children aged 2 to 59 months in this study. lack of circumcision among boys was associated with bacterial UTI. The bacterial isolate and susceptibility findings support the use of locally generated microbiological evidence to guide treatment decisions and antimicrobial stewardship.
Keywords: Bacterial Urinary Tract Infection, Febrile Children, Bacterial Isolates, Antibacterial Susceptibility, Antimicrobial Resistance.