FREQUENCY OF URINARY TRACT INFECTION IN SEPTICEMIA IN NEWBORNS IN REHMAN MEDICAL INSTITUTE PESHAWAR

Abstract

Background: Neonatal sepsis remains a leading cause of morbidity and mortality among newborns, particularly in developing countries. This study aimed to determine the frequency of urinary tract infection in neonates presenting with septicemia at Rehman Medical Institute, Peshawar, and to examine associated demographic and clinical factors.

Methods: This hospital-based cross-sectional study was conducted at the Department of Pediatrics, Rehman Medical Institute, Peshawar, over a six-month period following ethical approval from the institutional research ethics committee. A total of 133 neonates aged 1 to 28 days meeting the operational definition of neonatal sepsis were enrolled using non-probability consecutive sampling. Data were analyzed using SPSS version 29; frequencies and percentages were calculated for categorical variables, while mean ± standard deviation or median with interquartile range were reported for continuous variables. The chi-square test/Fisher's exact test was applied for stratified analysis, with p < 0.05 considered statistically significant.

Results: Of the 133 neonates with sepsis, 29 (21.8%; 95% CI: 15.1% to 29.7%) had a positive urine culture meeting the criteria for urinary tract infection. Low birth weight neonates (<2.5 kg) demonstrated a significantly higher UTI frequency than normal weight neonates (31.7% vs. 17.4%, p = 0.042). A significant inverse association was observed between parental education level and UTI frequency, with the highest rate among neonates of uneducated parents (33.3%) and the lowest among those with higher education (9.5%) (p for trend = 0.009). Socioeconomic status showed similar patterns, with UTI present in 31.6% of neonates from poor families compared to 12.5% from rich families (p = 0.035). Longer duration of symptoms before presentation was associated with increased UTI frequency (≤2 days: 12.5%; 3-5 days: 21.8%; ≥6 days: 36.7%; p for trend = 0.013). Gender and residential status showed no statistically significant associations with UTI frequency (p > 0.05). Multivariable logistic regression identified late neonatal age (adjusted OR: 2.54, 95% CI: 1.18-5.47, p = 0.017), low birth weight (adjusted OR: 2.21, 95% CI: 1.08-4.52, p = 0.030), uneducated parental status (adjusted OR: 3.42, 95% CI: 1.51-7.75, p = 0.003), and symptom duration ≥6 days (adjusted OR: 3.18, 95% CI: 1.42-7.12, p = 0.005) as independent predictors of UTI in neonates with sepsis.

Conclusions: Urinary tract infection is present in approximately one-fifth of neonates with sepsis at Rehman Medical Institute, Peshawar, with Gram-negative organisms, particularly Escherichia coli, being the predominant pathogens. Late neonatal age, low birth weight, uneducated parental status, lower socioeconomic status, and prolonged symptom duration are significantly associated with higher UTI frequency. The data provide locally relevant evidence to guide empirical antibiotic therapy and inform antimicrobial stewardship efforts in the region.