Could meningitis testing be omitted in febrile infants with positive UTI?

  • Wang ME & al.
  • Pediatrics
  • 01/09/2019

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In otherwise well-appearing infants with febrile urinary tract infection (UTI), omitting cerebrospinal fluid (CSF) testing to rule out meningitis yielded no cases of delayed bacterial meningitis at 7 days postdischarge in this study. 

Why this matters

  • These authors say that meningitis testing of infants aged 31-60 days with fever and positive urinalysis “may not be necessary.”
  • Sparing infants a spinal tap that adds little would be desirable.

Key results

  • 29.7% of the cohort did not have CSF testing and were treated for UTI.
  • Among these, none had delayed meningitis at 7 days (95% CI, 0%-0.6%).
  • CSF testing varied across sites and was more likely for infants aged 7-30 days.
  • Infants who had CSF testing more often (aORs; 95% CI): 
    • Were younger: 4.6 (3.8-5.5) days;
    • Had abnormal inflammatory markers: 2.2 (1.8-2.5); and
    • Were at higher volume centers (>300 infants with fever each year): 1.8 (1.2-2.6).

Study design

  • Retrospective cohort study including 20,570 infants, aged 7-60 days presenting with fever but well-appearing at 124 hospitals, 2015-2017.
  • Funding: None.

Limitations

  • No details on symptoms, laboratory studies, treatment used.
  • Retrospective design.