Clinical Spectrum and Microbiological Profile of Pediatric Urinary Tract Infections in Bangladesh: Insights from a Tertiary Care Study of a Low- and Middle-Income Country
Main Article Content
http://orcid.org/0000-0001-9542-5818
Nadira Sultana
http://orcid.org/0000-0002-6394-9008
Onia Akter
http://orcid.org/0009-0008-3782-1028
Abdullah Al-Mamun
http://orcid.org/0000-0001-6308-8159
Fahmida Begum
http://orcid.org/0000-0003-3999-3428
Mst Shanjida Sharmim
http://orcid.org/0000-0002-0682-4719
Amina Akter
http://orcid.org/0000-0001-9375-5805
Syed Saimul Huque
http://orcid.org/0000-0002-5095-7906
Salma Jahan
http://orcid.org/0000-0002-5095-7906
Afroza Begum
http://orcid.org/0000-0003-1894-9292
Tahmina Karim
http://orcid.org/0000-0001-9542-5818
Abstract
Background: Urinary tract infection is a common pediatric bacterial infection associated with significant morbidity and increasing antimicrobial resistance, particularly in low- and middle-income countries. Updated local data regarding microbiological patterns and antibiotic susceptibility in children with UTI remain limited in Bangladesh.
Methods: This cross-sectional study was conducted in the Department of Pediatric Nephrology, Bangladesh Medical University, from August 2023 to January 2026. Among 242 children aged <18 years with symptoms suggestive of UTI, 188 fulfilled criteria for presumptive UTI based on pyuria and/or positive dipstick findings. Urine culture and antibiotic susceptibility testing were performed for all presumptive cases. Children with asymptomatic bacteriuria, recent antibiotic exposure, prophylactic antibiotics, or contaminated cultures were excluded. Confirmed UTI was defined by significant growth of a single organism in urine culture. Demographic, clinical, microbiological, and antimicrobial susceptibility data were analyzed using SPSS version 26.0.
Results: Culture-positive UTI was identified in 78 children (41.5%). Females predominated (55.9%), and most patients were below five years of age. Fever (67.0%) and dysuria (39.4%) were the most common presenting symptoms. Associated renal disease was present in 60.1% of cases, most commonly nephrotic syndrome and hydronephrosis. Klebsiella species (38.5%) were the predominant uropathogens, followed by Escherichia coli (21.8%). Gram-negative isolates demonstrated high susceptibility to carbapenems, aminoglycosides, nitrofurantoin, and colistin, while resistance to commonly used antibiotics was substantial. Female sex, uncircumcised male infants, high-grade fever, and associated kidney disease were independent predictors of culture-positive UTI.
Conclusion: Pediatric UTIs in this tertiary nephrology setting were frequently associated with underlying renal abnormalities and multidrug-resistant non–E. coli organisms. Early urine culture, culture-guided therapy, and strengthened antimicrobial stewardship are essential to improve outcomes and limit antimicrobial resistance.
Article Details
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References
2. Chowdhury SS, Tahsin P, Xu Y, Mosaddek ASM, Muhamadali H, Goodacre R. Trends in Antimicrobial Resistance of Uropathogens Isolated from Urinary Tract Infections in a Tertiary Care Hospital in Dhaka, Bangladesh. Antibiotics (Basel). 2024;13(10). doi:10.3390/ANTIBIOTICS13100925
3. Majumder MMI, Mahadi AR, Ahmed T, Ahmed M, Uddin MN, Alam MZ. Antibiotic resistance pattern of microorganisms causing urinary tract infection: a 10-year comparative analysis in a tertiary care hospital of Bangladesh. Antimicrob Resist Infect Control. 2022;11(1). doi:10.1186/S13756-022-01197-6
4. Roberts KB, Downs SM, Finnell SME, et al. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011;128(3):595-610. doi:10.1542/PEDS.2011-1330
5. Daniel M, Szymanik-Grzelak H, Sierdziński J, Podsiadły E, Kowalewska-Młot M, Pańczyk-Tomaszewska M. Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. J Pers Med. 2023;13(1). doi:10.3390/JPM13010138
6. Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open. 2019;3(1):487. doi:10.1136/BMJPO-2019-000487
7. Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary Tract Infection in Children. Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):2-18. doi:10.2174/1872213X13666181228154940
8. Karmazyn BK, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria® Urinary Tract Infection—Child. Journal of the American College of Radiology. 2017;14(5):S362-S371. doi:10.1016/j.jacr.2017.02.028
9. Clark CJ, Kennedy WA, Shortliffe LD. Urinary tract infection in children: When to worry. Urologic Clinics of North America. 2010;37(2):229-241. doi:10.1016/j.ucl.2010.03.009
10. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health. 2017;37(4):273-279. doi:10.1080/20469047.2017.1382046
11. Shaikh N, Hoberman A, Keren R, et al. Recurrent Urinary Tract Infections in Children With Bladder and Bowel Dysfunction. Pediatrics. 2016;137(1). doi:10.1542/PEDS.2015-2982
12. Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clin Microbiol Rev. 2005;18(2):417-422. doi:10.1128/CMR.18.2.417-422.2005
13. Chang SL, Shortliffe LD. Pediatric Urinary Tract Infections. Pediatr Clin North Am. 2006;53(3):379-400. doi:10.1016/j.pcl.2006.02.011
14. Hewitt IK, Zucchetta P, Rigon L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials. Pediatrics. 2008;122(3):486-490. doi:10.1542/PEDS.2007-2894
15. Gunawan PY, Umboh A. The risk of urinary tract infection in children with nephrotic syndrome. Paediatr Indones. 2016;56(4):238-241. doi:10.14238/PI56.4.2016.238-41
16. Maringhini S, Alaygut D, Corrado C. Urinary Tract Infection in Children: An Up-To-Date Study. Biomedicines. 2024;12(11). doi:10.3390/BIOMEDICINES12112582
17. Nazme NI, Amin A Al, Jalil F, Sultana J, Fatema NN. Bacteriological Profile of Urinary Tract Infection in Children of a Tertiary Care Hospital. Bangladesh Journal of Child Health. 2017;41(2):77-83. doi:10.3329/BJCH.V41I2.36102
18. Zhou Y, Zhou Z, Zheng L, et al. Urinary Tract Infections Caused by Uropathogenic Escherichia coli: Mechanisms of Infection and Treatment Options. Int J Mol Sci. 2023;24(13):10537. doi:10.3390/IJMS241310537
19. Bitsori M, Maraki S, Koukouraki S, Galanakis E. Pseudomonas aeruginosa urinary tract infection in children: risk factors and outcomes. J Urol. 2012;187(1):260-264. doi:10.1016/J.JURO.2011.09.035
20. Radu VD, Onofrei P, Vaida M, Costache RC. Urinary tract infections with Burkholderia cepacia. A narrative review. Archive of Clinical Cases. 2024;11(3):86. doi:10.22551/2024.44.1103.10294
21. Nahar A, Hasnat S, Akhter H, Begum N, Professor A. Evaluation of antimicrobial resistance pattern of uropathogens in a tertiary care hospital in Dhaka city, Bangladesh. South East Asia Journal of Public Health. 2017;7(2):12-18. doi:10.3329/SEAJPH.V7I2.38851
22. Dash M, Padhi S, Mohanty I, Panda P, Parida B. Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India. J Family Community Med. 2013;20(1):20. doi:10.4103/2230-8229.108180
23. Shrestha LB, Baral R, Poudel P, Khanal B. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC Pediatr. 2019;19(1). doi:10.1186/S12887-019-1410-1