Febrile Young Infants With Altered Urinalysis at Low Risk for Invasive Bacterial Infection. A Spanish Pediatric Emergency Research Network’s Study

Abstract

We have derived a highly accurate prediction model for IBI in febrile infants with altered urinalysis. Given these results, outpatient management might be suitable for 1 of each 4 infants diagnosed, with a considerable improvement in resource utilization.

Using a urine dipstick to identify a positive urine culture in young febrile infants is as effective as in older patients

“…UTI is the most common serious bacterial infection in febrile infants of less than 90 days of age . Moreover, the risk of developing an IBI, mainly bacteraemia, secondary to UTI is higher in these patients . The gold standard for the diagnosis of UTI is the growth of a single pathogen in a urine culture .…”

“…This is a subanalysis of a multicentre observational prospective study designed to determine the risk of invasive bacterial infection (IBI) in febrile infants of less than 90 days of age with altered urinalysis according to their general appearance, age and laboratory tests .…”

Is It Time to Stop Classifying Febrile Infants With Positive Urinalyses as High-Risk for Meningitis?

“…1 To date, all of the criteria developed and commonly used for the risk stratification of febrile infants (Rochester, Philadelphia, Boston, Step-by-Step approach) include a positive urinalysis result as a parameter that classifies an infant as "not low-risk" for an invasive bacterial infection (ie, bacteremia and/or bacterial meningitis). 2-6 On 1 hand, this classification makes sense because the prevalence of bacteremia among infants with a positive urinalysis is ∼6% to 9%, [7][8][9] and these infants are theoretically at an increased risk for seeding the meninges leading to meningitis. However, with their data, Young et al 1 contradict this logic by showing that infants with a positive urinalysis are at no greater risk of meningitis than other febrile infants and that the urinalysis should not alter the pretest probability for meningitis in assessing the need for a lumbar puncture (LP) in this patient population.…”

Febrile infants and children in the emergency department: Reducing fever to its simplest form

“…In febrile infants in whom UTI has been diagnosed, many guidelines suggest that blood and CSF should be collected for culture because of the risk of concomitant bacteraemia and meningitis. However, this is unnecessary as a routine practice, particularly in infants over one month of age . The risk of bacteremia with UTI is around 6% .…”

“…However, this is unnecessary as a routine practice, particularly in infants over one month of age . The risk of bacteremia with UTI is around 6% . Risk factors for bacteremia included unwell appearance, high‐risk past medical history (defined as history of genitourinary abnormalities, previous UTIs, bacteraemia, meningitis, previous laboratory evaluation for fever, prematurity or history of a severe systemic disease), and age less than 22 days.…”