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J Pediatr. 2019 Sep;212:102-110.e5. doi: 10.1016/j.jpeds.2019.04.053. Epub 2019 Jun 21.

Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis.

Author information

1
General Pediatrics, Joint Base Langley-Eustis, Hampton, VA; Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: james.t.nugent2.mil@mail.mil.
2
Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD.
3
Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, VA.
4
Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD.
5
James A. Zimble Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
6
Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

Abstract

OBJECTIVE:

To determine the risk of bacterial meningitis in infants aged 29-90 days with evidence of urinary tract infection (UTI).

METHODS:

PubMed (MEDLINE), Embase, and the Cochrane Library were systematically searched for studies reporting rates of meningitis in infants aged 29-90 days with abnormal urinalysis or urine culture. Observational studies in infants with evidence of UTI who underwent lumbar puncture (LP) reporting age-specific event rates of bacterial meningitis and sterile cerebrospinal fluid pleocytosis were included. Prevalence estimates for bacterial meningitis in infants with UTI were pooled in a random effects meta-analysis.

RESULTS:

Three prospective and 17 retrospective cohort studies were included in the meta-analysis. The pooled prevalence of concomitant bacterial meningitis in infants with UTI was 0.25% (95% CI, 0.09%-0.70%). Rates of sterile pleocytosis ranged from 0% to 29%. Variation in study methods precluded calculation of a pooled estimate for sterile pleocytosis. In most studies, the decision to perform a LP was up to the provider, introducing selection bias into the prevalence estimate.

CONCLUSIONS:

The risk of bacterial meningitis in infants aged 29-90 days with evidence of UTI is low. A selective approach to LP in infants identified as low risk for meningitis by other clinical criteria may be indicated.

KEYWORDS:

febrile infant; lumbar puncture; serious bacterial infection; sterile pleocytosis

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