Abstract / Summary
Background: Urinary tract infection (UTI) is an important bacterial infection in children and may present with nonspecific manifestations, particularly in younger children. Early recognition of UTI among febrile children is important to facilitate appropriate urine testing and treatment and to avoid unnecessary antibiotic use. Objectives: To identify the clinical predictors associated with urinary tract infection in febrile children and to evaluate the diagnostic performance of selected clinical characteristics in predicting UTI. Patients and methods: A cross-sectional hospital-based study was conducted at Mosul General Hospital, Nineveh Governorate, Iraq, from August 2025 to May 2026. The study included 189 febrile children who were evaluated for possible UTI. Demographic and clinical characteristics, fever features, urinary symptoms, and physical examination findings were recorded. Urinalysis and urine culture were performed, and clinical predictors of culture-confirmed UTI were assessed. Statistical analysis was performed using SPSS version 31, including comparative analysis, multivariable logistic regression, and receiver operating characteristic curve analysis. Results: Among the 189 febrile children, 58 (30.7%) had positive urine cultures. Escherichia coli was the predominant isolated organism, accounting for 67.2% of culture-positive cases. Female sex was significantly more frequent among children with UTI (63.8% vs. 38.9%, P=0.002). UTI was also significantly associated with fever ≥39°C, fever lasting more than 3 days, fever without an obvious source, and previous UTI. Dysuria, increased urinary frequency, urinary urgency, suprapubic pain, flank or loin pain, foul-smelling urine, and hematuria were significantly more common among UTI-positive children. Multivariable analysis identified female sex, prolonged fever, fever without an obvious source, previous UTI, dysuria, increased urinary frequency, suprapubic pain, and flank or loin pain as independent predictors of UTI. Dysuria demonstrated the highest diagnostic performance among individual clinical predictors (AUC=0.678), while the combination of clinical predictors showed better discrimination (AUC=0.801), with 75.9% sensitivity and 72.5% specificity. Conclusions: UTI was a relatively common finding among febrile children in the present study. Female sex, prolonged fever, fever without an obvious source, previous UTI, and specific urinary symptoms were important clinical predictors. A combination of clinical characteristics provided better diagnostic performance than individual predictors and may assist clinicians in identifying febrile children who require urine evaluation. Nevertheless, urinalysis and appropriately collected urine culture remain essential for confirming the diagnosis.