Background: UTI remains a leading bacterial infection with potential for severe long-term morbidity, including renal scarring, hypertension, and CKD. The identification of modifiable risk factors is essential for targeted prevention. This study aimed to comprehensively evaluate factors associated with pediatric UTI in a hospital setting in Sabzevar, Iran.

Methods: This cross-sectional study enrolled 150 children under 16 years hospitalized with confirmed UTI and 150 age-matched controls hospitalized for non-UTI conditions. Data on demographic, socioeconomic, clinical, and behavioral variables were extracted from medical records and structured parental interviews. Statistical analyses included independent t-tests, Chi-square, and Fisher’s exact tests, with significance set at p < 0.05.

Results: Among UTI cases, 120 (80%) were female and 30 (20%) male (mean age: 5.0 ± 1.8 years). Significant risk factors included female sex (p < 0.001), improper perineal hygiene (p < 0.001), uncircumcised status in males (p < 0.001), vesicoureteral reflux (VUR) (p < 0.001), constipation (p = 0.009), neurogenic bladder (p < 0.001), lack of toilet training (p < 0.001), tight underwear use (p < 0.001), bathtub use (p = 0.003), catheterization (p = 0.007), low socioeconomic status (SES) (p < 0.001), rural residence (p < 0.001), growth disorder (p < 0.001), prior UTI history (p < 0.001), family history of kidney stones (p = 0.001), and positive C-reactive protein (p < 0.001). Maternal education (p = 0.06) and labial adhesion (p = 1.00) showed no significant association.

Conclusion: Beyond established anatomical and physiological factors, socioeconomic status, hygiene practices, and behavioral patterns significantly contribute to UTI. Early identification and educational interventions addressing these risks are critical to reducing recurrent infections and long-term renal complications.