James Nugent1, Molly Childers2, Nicholas Singh-Miller3, Robin Howard4, Rhonda Allard5, Matthew Eberly6. 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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Authors: Lyubina C Yankova; Mark I Neuman; Marie E Wang; Christopher Woll; Adrienne G DePorre; Sanyukta Desai; Laura F Sartori; Lise E Nigrovic; Christopher M Pruitt; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Fran Balamuth; Paul L Aronson Journal: Hosp Pediatr Date: 2020-12
Authors: Paul L Aronson; Mary C Politi; Paula Schaeffer; Eduardo Fleischer; Eugene D Shapiro; Linda M Niccolai; Elizabeth R Alpern; Steven L Bernstein; Liana Fraenkel Journal: Acad Emerg Med Date: 2020-09-09 Impact factor: 3.451