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Observational Study
. 2022 Oct 1;150(4):e2021055633.
doi: 10.1542/peds.2021-055633.

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results

Prashant Mahajan  1 , John M VanBuren  2 , Leah Tzimenatos  3 , Andrea T Cruz  4 , Melissa Vitale  5 , Elizabeth C Powell  6 , Aaron N Leetch  7 , Michelle L Pickett  8 , Anne Brayer  9 , Lise E Nigrovic  10 , Peter S Dayan  11 , Shireen M Atabaki  12 , Richard M Ruddy  13 , Alexander J Rogers  14   15 , Richard Greenberg  2 , Elizabeth R Alpern  16 , Michael G Tunik  17 , Mary Saunders  8 , Jared Muenzer  18 , Deborah A Levine  17   19 , John D Hoyle  20 , Kathleen Grisanti Lillis  21 , Rajender Gattu  22 , Ellen F Crain  23 , Dominic Borgialli  15   24 , Bema Bonsu  25 , Stephen Blumberg  23 , Jennifer Anders  26 , Genie Roosevelt  27 , Lorin R Browne  8 , Daniel M Cohen  28 , James G Linakis  29 , David M Jaffe  18 , Jonathan E Bennett  30 , David Schnadower  18 , Grace Park  31 , Rakesh D Mistry  27 , Eric W Glissmeyer  2 , Allison Cator  14   15 , Amanda Bogie  32 , Kimberly S Quayle  18 , Angela Ellison  16 , Fran Balamuth  16 , Rachel Richards  2 , Octavio Ramilo  33 , Nathan Kuppermann  3   34 ; Pediatric Emergency Care Applied Research Network (PECARN)
Affiliations
Observational Study

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results

Prashant Mahajan et al. Pediatrics. .

Abstract

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.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Ramilo reports personal fees from Sanofi-Pasteur, Merck, and Pfizer, and grants from Janssen and the Bill & Melinda Gates Foundation. These fees and grants are not related to this study. Dr Hoyle holds the United States patents of 2 drug dosing devices. Currently, there are no licensing arrangements, royalty streams or other financial arrangements. The other authors have indicated they have no potential conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Patient enrollment.
See this image and copyright information in PMC

References

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    1. Powell EC, Mahajan PV, Roosevelt G, et al. ; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) . Epidemiology of bacteremia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018;71(2):211–216 - PMC - PubMed
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