Investigation of the rate of meningitis in association with urinary tract infection in infants 90�days of age or younger

Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Emergency medicine Australasia: EMA (Impact Factor: 1.3). 11/2007; 19(5):464-9. DOI: 10.1111/j.1742-6723.2007.01001.x
Source: PubMed


To test the hypothesis that urinary tract infections (UTI) in young infants are rarely associated with meningitis.
We undertook a review of the laboratory results from 322 infants, 90 days of age or younger, with an admission or discharge diagnosis of UTI or meningitis. The study was conducted in a tertiary paediatric hospital. The primary outcome measure was the incidence of coexisting urinary tract and cerebrospinal fluid sepsis.
In total, 161 of the 322 (50%) infants with an admission or discharge diagnosis of UTI or meningitis were subsequently shown to have a culture-proven UTI. Of the children with a culture-proven UTI, 75 (47%) had cerebrospinal fluid obtained. We detected one case of probable bacterial meningitis in association with UTI.
UTI is rarely associated with meningitis in infants 90 days of age or younger.

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    • "The spectrum and frequency of bacterial pathogens causing UTI in our study is consistent with previous pediatric studies, with E. coli accounting for more than two thirds of infections [3]–[6], [13], [14], [16], [18], [32], [33]. Similar to other reports Enterococcus, Klebsiella and Enterobacter species were also commonly implicated [3], [5]–[7], [14], [16], [18]. "
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    ABSTRACT: The primary aim of this study was to determine age-stratified rates of co-existing bacterial meningitis in children with urinary tract infection (UTI). The secondary aims of this study were to determine the causative pathogens of UTI, and the clinical features and outcome of children with co-existing meningitis. Analysis of data collected over a nine-year period at a tertiary pediatric hospital in Australia. Study population: children below 16 years of age with culture-confirmed UTI and a paired CSF sample. A total of 748 episodes in 735 cases were included in the final analysis. The commonest pathogens causing UTI were Escherichia coli (67.4%), Enterococcus faecalis (8.4%), Klebsiella oxytoca (3.5%) and Klebsiella pneumoniae (3.5%). Only two (1.2%; 95% CI: 0.15-4.36%) of 163 neonates (between 0 and 28 days of age) with UTI had co-existing meningitis. Both presented with pyrexia, irritability and lethargy, and recovered uneventfully with antibiotic treatment. There were no cases of co-existing meningitis among 499 infants (between 29 days and 12 months of age) with UTI (95% CI: 0.00-0.74%), or any of the 86 children aged 12 months or over (95% CI: 0.00-4.20%). These findings indicate that clinicians should have a low threshold to perform a lumbar puncture in neonates with UTI, as the risk of co-existing meningitis is not insignificant in this age group. In contrast, beyond the neonatal period, the risk is small and a more selective approach is warranted.
    PLoS ONE 11/2011; 6(11):e26576. DOI:10.1371/journal.pone.0026576 · 3.23 Impact Factor
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    ABSTRACT: Our aim is to reduce the rate of lumbar spinal tapping and voiding cystourethrography (VCUG) in febrile urinary tract infection (UTI) infants less than 3 months of age.
    Journal of the Korean Society of Pediatric Nephrology 01/2009; 13(1). DOI:10.3339/jkspn.2009.13.1.33
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    ABSTRACT: To determine the incidence of sterile cerebrospinal fluid (CSF) pleocytosis in infants ≤6 months old with urinary tract infection (UTI). Retrospective study of children admitted to a tertiary children's hospital in 2006 and 2007 with UTI who also had a lumbar puncture performed. All urine specimens were tested for anti-microbial activity. Twelve (11.3%) of 106 infants with UTI had concurrent CSF pleocytosis. None of these patients had anti-microbial activity in the urine, showing that they had not received prior antibiotics. None of the 15 neonates (≤28 days old) with UTI and lumbar puncture had CSF pleocytosis. Antibiotics were stopped after a maximum of 10 days. Our results are compatible with published reports on the proportion of infants with UTI who have concurrent sterile CSF pleocytosis. We were able to exclude previous antibiotic therapy by measuring urinary anti-microbial activity. Our work supports the hypothesis that CSF pleocytosis in UTI is inflammatory and not because of infection of the central nervous system.
    Journal of Paediatrics and Child Health 05/2009; 45(6):364-7. DOI:10.1111/j.1440-1754.2009.01502.x · 1.15 Impact Factor
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