Clinical Symptoms and Factors Associated with Culture-Positive Urinary Tract Infection Among Patients with Suspected UTI in a Tertiary Hospital in Bangladesh

Open Access

Abstract

Background: Clinical symptoms are commonly used to identify patients with suspected urinary tract infection (UTI), although individual symptoms do not uniformly correspond with positive urine cultures. Evidence regarding clinical factors independently associated with culture positivity remains limited in Bangladeshi tertiary-care settings. Objective: To assess clinical symptoms and patient characteristics associated with positive urine culture among patients with suspected UTI in a tertiary hospital in Bangladesh. Methods & Materials: A secondary analysis of a cross-sectional analytical study was conducted in the Department of Microbiology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh, from January to December 2020 using data from 229 patients with clinically suspected UTI attending inpatient and outpatient services of Mitford Hospital, Dhaka. Demographic characteristics, urinary symptoms, antibiotic history, hospitalization status, and urine culture findings were analyzed. Pearson's chi-square test and univariable logistic regression were used for initial associations, followed by multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported, with p<0.05 considered statistically significant. Results: Bacterial growth was detected in 138/229 (60.26%) patients, and Escherichia coli accounted for 113/138 (81.88%) positive cultures. Burning during micturition, increased urinary frequency, and urgency were significantly more frequent among culture-positive patients, all p<0.001. After multivariable adjustment, urgency showed the strongest association with culture positivity, aOR 2.83, 95% CI 1.55-5.17, p=0.001, followed by increased urinary frequency, aOR 2.70, 95% CI 1.48-4.92, p=0.001, and burning during micturition, aOR 2.55, 95% CI 1.41-4.61, p=0.002. Female sex, aOR 1.83, 95% CI 1.05-3.19, p=0.033, and age 20-39 years, aOR 2.31, 95% CI 1.08-4.94, p=0.031, were also independently associated with culture positivity. Fever and antibiotic history were not independently associated. Conclusion: Positive urine culture was common among clinically suspected UTI patients. Urgency, increased frequency, burning during micturition, female sex, and age 20-39 years were independently associated with culture positivity and may help characterize patients more likely to have microbiologically confirmed infection.