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Bacterial meningitis is infrequently predicted by positive urinalysis in infants younger than 2 months
Clinical Question
How often are bacteremia and bacterial meningitis associated with a positive urinalysis in febrile infants younger than 60 days?
Bottom line
Approximately 1 in 17 (5.8%) febrile infants younger than 2 months with a positive UA result will also be bacteremic. In infants 28 days or younger, the rate of bacterial meningitis was similar in those with and without a positive UA; for infants in their second month of age, meningitis rates were higher in febrile infants with a negative UA. 1b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Emergency department
Synopsis
This multicenter study, conducted in pediatric emergency departments in the United States, evaluated a convenience sample of 7180 noncritical (ie, not requiring intubation or blood pressure support) febrile infants 60 days or younger for whom urinalysis (UA), blood culture, and cerebrospinal fluid analysis were conducted. Results were available for 96.9% of eligible participants. The authors excluded premature infants, those with significant comorbid conditions, and those who had recent antibiotic treatment. The rate of positive UA was 15.2%. Bacteremia rates were low but were more likely in those with positive UA results (5.8% vs 1.1%). Whether the UA was positive or negative, bacterial meningitis was similarly common (~ 1%) in infants 28 days or younger. In infants 29 to 60 days of age, there were no cases of meningitis in patients with positive UA results and 9 cases (0.2%) in children with negative UA results.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA