The rate of concomitant bacterial meningitis in infants with urinary tract infection is 0.25%

Reference

Nugent J, Childers M, Singh-Miller N, Howard R, Allard R, Eberly M. Risk of meningitis in infants aged 29 to 90 days with urinary tract infection: A systematic review and meta-analysis. J Pediatr 2019;212:102-110 e105.

Synopsis

These authors searched 3 databases to identify studies that reported the rate of bacterial meningitis in 29- to 90-day-old infants with UTIs. They manually searched the reference lists of identified studies. The authors don't describe if 2 or more authors independently selected articles or assessed the methodologic quality of included studies, and they also don't describe the potential for publication bias. Ultimately, they identified 21 observational studies, 20 of which provided data with which to perform a meta-analysis. The studies included as few as 3 infants and as many as 1609! Nine studies included only febrile infants and 11 included infants with evidence of UTI but who were not necessarily febrile. Sixteen of the included studies reported rates of meningitis in infants with culture-confirmed UTI and the other 4 included infants with an abnormal urinalysis. In all 3 of the prospective studies, the clinicians performed lumbar punctures on febrile infants. Among the 18 retrospective studies, only 2 were in settings in which all the infants had lumbar punctures. Overall, the included studies were of moderate to high quality. Among the 3868 infants with either an abnormal urinalysis or culture-confirmed UTI, 11 (0.28%) had bacterial meningitis. After some statistical gymnastics to account for variability among the studies, the authors estimate the rate of bacterial meningitis to be 0.25% (95% CI 0.09% - 0.70%). The recommendations for when to perform a lumbar puncture in infants with a UTI are inconsistent. Since the included studies only reported on those infants for whom a lumbar puncture was performed, it is possible that these data are not a true reflection of the actual rate.