Thursday 13 August 2020

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Neonates With Urinary Tract Infection

Is a Lumbar Puncture Always Indicated?

Hernández-Bou, Susanna MD; Trenchs, Victoria MD, PhD; Cano, Iván MD; Girona, Mònica MD; Luaces, Carles MD, PhD

Author Information
The Pediatric Infectious Disease Journal: September 2020 - Volume 39 - Issue 9 - p 849-853
doi: 10.1097/INF.0000000000002683
  • BUY
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Abstract

Background: 

Our objectives were to determine the prevalence of and to identify risk factors for coexisting bacterial meningitis (BM) in neonates with urinary tract infection (UTI).

Methods: 

A cross-sectional study was conducted at pediatric emergency department of a tertiary teaching hospital from 2001 to 2017. Infants <29 days of age with UTI (≥10,000 colony-forming units/mL of a single pathogen from a catheterized specimen in association with positive urinalysis) were included. Definite BM was defined as growth of a single bacterial pathogen from a cerebrospinal fluid (CSF) sample and probable BM as (1) positive blood culture with CSF pleocytosis and treatment consistent with BM or (2) antibiotic pretreatment before lumbar puncture, CSF pleocytosis and treatment consistent with BM. Univariate testing was used to identify possible risk factors associated with BM. Receiver operating characteristics curves were constructed for the laboratory markers associated with BM.

Results: 

Three hundred seventy-one infants were included. Five [1.3%; 95% confidence interval (CI): 0.6%–3.1%] had BM: 4 definite BM and 1 probable BM. Risk factors detected for BM were classified as not being well-appearing and a procalcitonin value ≥0.35 ng/mL [sensitivity of 100% (95% CI: 56.6%–100%) and negative predictive value of 100% (95% CI: 96.1%–100%)].

Conclusions: 

Coexisting BM occurs uncommonly in neonates with UTI. Well-appearing neonates with UTI and procalcitonin value <0.35 ng/mL were at very low risk for BM; avoiding routine lumbar puncture in these patients should be considered.

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