Abstract:
Urinary tract infections (UTI) is one of the most common pediatric infections
and contribute to morbidity and mortality. Different studies revealed that the magnitude of
urinary tract infections among under-five children is most common and varies from place to
place. However, there are limited studies on UTI among children in Ethiopia, especially in
this area.
Objective: To assess the prevalence, associated factors, and antimicrobial susceptibility
pattern of bacterial urinary tract infection among under-five children at Hiwot Fana
Specialized University Hospital, Harar, eastern Ethiopia from March 20 to June 10, 2021.
Methods: An institutional-based cross-sectional study was conducted among 332
conveniently selected all under-five children. A pretested structured questionnaire was used
to collect data on sociodemographic, clinical features, medical history, and associated factors
by interviewing parents/guardians. Urine samples were collected aseptically and performed
bacterial isolation using colony morphology, gram stain, and a panel of biochemical tests.
The drug susceptibility pattern of isolates was determined using the Modified Kirby-Bauer
Disk Diffusion techniques. Data were entered into Epi info version 7 and analyzed using
Statistical Package for the Social Sciences (SPSS) version 25.
Result: The overall prevalence of urinary tract infections was 24.1 % (95% CI: 19.4-29). The
predominant isolate was E. coli (28.75%) followed by K. pneumoniae (12.5%). Being rural
resident (AOR: 4.089, 95%CI: 1.449 11.539), uncircumcised male (AOR: 3.523, 95%CI:
1.328, 9.385), hematuria (AOR: 2.96, 95%CI: 1.82, 7.42), previous history of antibiotic
usage (AOR: 7.315, 95%CI: 2.109, 25.368), previous history of urinary tract infection (AOR:
5.64, 95% CI: 1.36, 23.376), indwelling catheterization (AOR: 10.350, 95%CI: 3.742,
28.630), temperature ≥ 38.5 (AOR: 3.995, 95%CI: 1.544, 10.331), and urinary frequency
(AOR: 5.558, 95%CI: 2.025, 15.253) were significantly associated with urinary tract
infections at p<0.05. About 92.7% of Gram-negative isolates were susceptible to Meropenem
and 81.25% of Gram-positive bacteria were susceptible to Ciprofloxacin. The overall
multidrug resistance rate of the isolates was 61.6% (95% CI: 51-73).
Conclusion: The prevalence of urinary tract infections in the present study from under-five
children was relatively higher compared with most of the previous studies in different parts
of Africa. A high rate of multi-drug resistance strains was seen in the current study. Hence
health information dissemination on urinary tract infections prevention based on the
identified associated factors and appropriate antibiotic use is recommended to patients and
their parents. Treatment of urinary tract infection in children should be supported with
culture and drug susceptibility tests
