Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis

J Pediatr. 2019 Sep;212:102-110.e5. doi: 10.1016/j.jpeds.2019.04.053. Epub 2019 Jun 21.

Abstract

Objective: To determine the risk of bacterial meningitis in infants aged 29-90 days with evidence of urinary tract infection (UTI).

Methods: PubMed (MEDLINE), Embase, and the Cochrane Library were systematically searched for studies reporting rates of meningitis in infants aged 29-90 days with abnormal urinalysis or urine culture. Observational studies in infants with evidence of UTI who underwent lumbar puncture (LP) reporting age-specific event rates of bacterial meningitis and sterile cerebrospinal fluid pleocytosis were included. Prevalence estimates for bacterial meningitis in infants with UTI were pooled in a random effects meta-analysis.

Results: Three prospective and 17 retrospective cohort studies were included in the meta-analysis. The pooled prevalence of concomitant bacterial meningitis in infants with UTI was 0.25% (95% CI, 0.09%-0.70%). Rates of sterile pleocytosis ranged from 0% to 29%. Variation in study methods precluded calculation of a pooled estimate for sterile pleocytosis. In most studies, the decision to perform a LP was up to the provider, introducing selection bias into the prevalence estimate.

Conclusions: The risk of bacterial meningitis in infants aged 29-90 days with evidence of UTI is low. A selective approach to LP in infants identified as low risk for meningitis by other clinical criteria may be indicated.

Keywords: febrile infant; lumbar puncture; serious bacterial infection; sterile pleocytosis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Humans
  • Infant
  • Infant, Newborn
  • Meningitis, Bacterial / cerebrospinal fluid
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / etiology
  • Risk Assessment
  • Spinal Puncture / adverse effects
  • Urinary Tract Infections / epidemiology*
  • Urinary Tract Infections / microbiology

Substances

  • Anti-Bacterial Agents