In Brief | Paediatrics & Neonatology | Infectious Diseases
 

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results 

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This article is a summary of a study originally published in Paediatrics. It does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.

Urinary tract infections in very young infants are thought to have a high association with bacterial meningitis. For this reason, routine lumbar punctures are often performed on these infants. 

According to the researchers of this paper, Mahajan et al, the benefits of such a common intervention were unknown. They set out to determine whether conducting a lumbar puncture in febrile infants ( 29-60 days old) who presented with a positive urinalysis was indicated to assess the presence of bacterial meningitis.

Their study reviewed data from 7180 noncritical, febrile infants ( temperature of ≥38°)  who presented at a network of emergency departments, whose blood culture and urinary analysis were available for review. Their findings were as follows:
 

• One thousand ninety (15.2%) of the total sample of infants had positive urinary analysis results. The risk of bacteremia was higher in these infants than in those with a negative urinary analysis result.
• There was no difference in the prevalence of bacterial meningitis in either group of infants aged less than 28 days. 
• In infants aged between 29 and 60 days, no cases of bacterial meningitis were recorded in patients with a positive UA result. 
• In contrast, nine infants in the same age group with a negative UA result developed bacterial meningitis. 
• In infants 60 days or older, there were no cases of bacteremia and bacterial meningitis. 

The researchers concluded there was no clear evidence to support the assumption that non-critical febrile infants with positive UA results were at higher risk of bacteremia or bacterial meningitis. This information should guide clinical decision-making regarding administering routine lumbar punctures in such cases.

Access the original article 
Mahajan, P., VanBuren, J. M., Tzimenatos, L., Cruz, A. T., Vitale, M., Powell, E. C., Leetch, A. N., Pickett, M. L., Brayer, A., Nigrovic, L. E., Dayan, P. S., Atabaki, S. M., Ruddy, R. M., Rogers, A. J., Greenberg, R., Alpern, E. R., Tunik, M. G., Saunders, M., Muenzer, J., Levine, D. A., … Pediatric Emergency Care Applied Research Network (PECARN) (2022). Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics, 150(4), e2021055633. https://doi.org/10.1542/peds.2021-055633