Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections

Arch Pediatr Adolesc Med. 2011 Jul;165(7):635-41. doi: 10.1001/archpediatrics.2011.104.


Objectives: To determine the prevalence of and to identify risk factors for sterile cerebrospinal fluid (CSF) pleocytosis in a large sample of febrile young infants with urinary tract infections (UTIs) and to describe the clinical courses of those patients.

Design: Secondary analysis of a multicenter retrospective review.

Setting: Emergency departments of 20 North American hospitals. Patients Infants aged 29 to 60 days with temperatures of 38.0°C or higher and culture-proven UTIs who underwent a nontraumatic lumbar puncture from January 1, 1995, through May 31, 2006.

Main exposure: Febrile UTI.

Outcome measures: Presence of sterile CSF pleocytosis defined as CSF white blood cell count of 10/μL or higher in the absence of bacterial meningitis and clinical course and treatment (ie, presence of adverse events, time to defervescence, duration of parenteral antibiotic treatment, and length of hospitalization).

Results: A total of 214 of 1190 infants had sterile CSF pleocytosis (18.0%; 95% confidence interval, 15.9%-20.3%). Only the peripheral white blood cell count was independently associated with sterile CSF pleocytosis, and patients with a peripheral white blood cell count of 15/μL or higher had twice the odds of having sterile CSF pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P = .001). In the subset of patients at very low risk for adverse events (ie, not clinically ill in the emergency department and without a high-risk medical history), patients with and without sterile CSF pleocytosis had similar clinical courses; however, patients with CSF pleocytosis had longer parenteral antibiotics courses (median length, 4 days [interquartile range, 3-6 days] vs 3 days [interquartile range, 3-5 days]) (P = .04).

Conclusion: Sterile CSF pleocytosis occurs in 18% of young infants with UTIs. Patients with CSF pleocytosis at very low risk for adverse events may not require longer treatment with antibiotics.

Publication types

  • Multicenter Study

MeSH terms

  • Chi-Square Distribution
  • Female
  • Fever / cerebrospinal fluid*
  • Humans
  • Infant
  • Infant, Newborn
  • Leukocytosis / cerebrospinal fluid*
  • Leukocytosis / epidemiology
  • Male
  • Prevalence
  • ROC Curve
  • Retrospective Studies
  • Risk Factors
  • Spinal Puncture
  • Statistics, Nonparametric
  • Urinary Tract Infections / cerebrospinal fluid*