TY - JOUR
T1 - Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results
AU - Pediatric Emergency Care Applied Research Network (PECARN)
AU - Mahajan, Prashant
AU - VanBuren, John M.
AU - Tzimenatos, Leah
AU - Cruz, Andrea T.
AU - Vitale, Melissa
AU - Powell, Elizabeth C.
AU - Leetch, Aaron N.
AU - Pickett, Michelle L.
AU - Brayer, Anne
AU - Nigrovic, Lise E.
AU - Dayan, Peter S.
AU - Atabaki, Shireen M.
AU - Ruddy, Richard M.
AU - Rogers, Alexander J.
AU - Greenberg, Richard
AU - Alpern, Elizabeth R.
AU - Tunik, Michael G.
AU - Saunders, Mary
AU - Muenzer, Jared
AU - Levine, Deborah A.
AU - Hoyle, John D.
AU - Lillis, Kathleen Grisanti
AU - Gattu, Rajender
AU - Crain, Ellen F.
AU - Borgialli, Dominic
AU - Bonsu, Bema
AU - Blumberg, Stephen
AU - Anders, Jennifer
AU - Roosevelt, Genie
AU - Browne, Lorin R.
AU - Cohen, Daniel M.
AU - Linakis, James G.
AU - Jaffe, David M.
AU - Bennett, Jonathan E.
AU - Schnadower, David
AU - Park, Grace
AU - Mistry, Rakesh D.
AU - Glissmeyer, Eric W.
AU - Cator, Allison
AU - Bogie, Amanda
AU - Quayle, Kimberly S.
AU - Ellison, Angela
AU - Balamuth, Fran
AU - Richards, Rachel
AU - Ramilo, Octavio
AU - Kuppermann, Nathan
N1 - Publisher Copyright:
Copyright © 2022 by the American Academy of Pediatrics.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS: Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS: Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. CONCLUSIONS: Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.
AB - It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS: Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS: Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. CONCLUSIONS: Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.
UR - http://www.scopus.com/inward/record.url?scp=85139157583&partnerID=8YFLogxK
U2 - 10.1542/peds.2021-055633
DO - 10.1542/peds.2021-055633
M3 - Article
C2 - 36097858
AN - SCOPUS:85139157583
VL - 150
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 4
ER -