PREVALENCE, ASSOCIATED FACTORS AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF BACTERIAL URINARY TRACT INFECTIONS AMONG CLINICALLY SUSPECTED UNDER FIVE CHILDREN AT HIWOT FANA SPECIALIZED UNIVERSITY HOSPITAL, HARAR, EASTERN ETHIOPIA

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