Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results

Abstract

IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems.Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial.OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required.DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included.STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred ReportingItems for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using randomeffect models. MAIN OUTCOMES AND MEASURESThe primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTSThe parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCEIn this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis (continued) Key Points Question Are well-appearing febrile infants 29 to 60 days of age with positive urinalysis results at increased risk for bacterial meningitis? Findings In a systematic review and meta-analysis of 17 distinct international data sets (25 374 infants), the pooled prevalence of bacterial meningitis among infants with positive urinalysis results ranged from 0.25% (by cerebrospinal fluid [CSF] cultures or clinical definition) to 0.44% (by CS...

Trends in emergency medicine resident procedural reporting over a 10‐year period

“…the need for lumbar puncture in situations where they were previously performed (e.g., subarachnoid hemorrhage, febrile infants). 7,8 Another pattern in these data is that procedures with the highest rates (e.g., adult medical and trauma resuscitations, POCUS) also tended to have the greatest separation between the ACGME minimum requirement and the number recorded for graduating residents. The inverse pattern was observed for the rarest procedures (e.g., cricothyroidotomy, pericardiocentesis, cardiac pacing).…”

“…Further study is warranted to better understand this trend, including whether increased clinical POCUS imaging is related to increased use of similar POCUS exams or a broadening of the types of POCUS exams used in the clinical environment. Regarding the decreasing number of lumbar punctures performed by graduating residents, factors may include advances in knowledge and adoption of clinical pathways that obviate the need for lumbar puncture in situations where they were previously performed (e.g., subarachnoid hemorrhage, febrile infants) 7,8 …”

“…(6)(7)(8) 6(5)(6) 4 (4-4)28 (27-29) 23 (22-24) 18 (17-19) 18 (17-19) 16 (16-17) 15 (14-15) 7 (7-7) 6 (6-7) 4 (4-4)…”

Errors in Table 1 and Table 3

“…In the Original Investigation titled “Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2,” published May 12, 2023, there were errors in Table 1 and Table 3. In Table 1, the No.…”

“…(%) of SARS-CoV-2–negative infants aged 29 to 60 days should have been “6931 (65.1).” In Table 3, the No. (%) [95% CI] of SARS-CoV-2–positive infants with bacterial meningitis should have been “3 (<0.1) [0-0.2].” This article has been corrected …”