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J Pediatr. 2017 May;184:199-203. doi: 10.1016/j.jpeds.2017.01.022. Epub 2017 Feb 6.

Prevalence of Concomitant Acute Bacterial Meningitis in Neonates with Febrile Urinary Tract Infection: A Retrospective Cross-Sectional Study.

Author information

1
Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
2
Department of Student Affairs, Baylor College of Medicine, Houston, TX.
3
Section of Pediatric Emergency Medicine, Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Abstract

OBJECTIVE:

To describe the frequency of concomitant acute bacterial meningitis (ABM) in neonates with febrile urinary tract infection (UTI).

STUDY DESIGN:

This was a retrospective cross-sectional study from 2005 to 2013 of infants ≤30 days old evaluated in the emergency department of a quaternary care children's hospital with fever and laboratory-confirmed UTI. Definite ABM was defined as cerebrospinal fluid (CSF) culture with growth of pathogenic bacteria and probable ABM if pleocytosis with ≥ 20 white blood cell was present in an antibiotic-pretreated patient. The timing of lumbar puncture and first antibiotic dose was recorded to assess for antibiotic pretreatment.

RESULTS:

A total of 236 neonates with UTI were included. Mean age was 18.6 days (SD 6.2); 79% were male infants. Twenty-three (9.7%) had bacteremia. Fourteen (6%) were pretreated. No neonate (0%; 95% CI 0%-1.6%) had definite ABM and 2 (0.8%; 95% CI 0.1%-3.0%) neonates with bloody CSF had probable ABM. CSF white blood cell count was 25 and 183 for these 2 infants, and CSF red blood cell count was 3100 and 61 932, respectively. Another neonate had herpes simplex virus meningoencephalitis.

CONCLUSIONS:

The frequency of ABM in neonates with febrile UTI is low. Further prospective studies are needed to evaluate the safety of a tiered approach to evaluate for serious bacterial infection, in which lumbar puncture potentially could be avoided in well-appearing febrile neonates with suspected UTI.

KEYWORDS:

fever; meningitis; neonate; urinary tract infection

PMID:
28185626
DOI:
10.1016/j.jpeds.2017.01.022
[Indexed for MEDLINE]

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