Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results

Pediatrics. 2022 Oct 1;150(4):e2021055633. doi: 10.1542/peds.2021-055633.

Abstract

It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis.

Objective: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results.

Methods: Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results.

Results: Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL.

Conclusions: Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

Publication types

  • Observational Study

MeSH terms

  • Bacteremia* / complications
  • Bacteremia* / diagnosis
  • Bacteremia* / epidemiology
  • Bacterial Infections* / complications
  • Child
  • Fever / complications
  • Fever / diagnosis
  • Fever / epidemiology
  • Humans
  • Infant
  • Meningitis, Bacterial* / complications
  • Meningitis, Bacterial* / diagnosis
  • Meningitis, Bacterial* / epidemiology
  • Procalcitonin
  • Urinalysis
  • Urinary Tract Infections* / epidemiology

Substances

  • Procalcitonin