TY - JOUR
T1 - Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results
AU - for the 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:
© 2022 American Academy of Pediatrics. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile ab 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 $38C 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 - OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile ab 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 $38C 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
SN - 0031-4005
VL - 150
JO - Pediatrics
JF - Pediatrics
IS - 4
M1 - e2021055633
ER -