Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results-Reference-Cited by-同舟云学术

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results

Published:2022-09-13 Issue:4 Volume:150 Page:
ISSN:0031-4005
Container-title:Pediatrics
language:en
Short-container-title:

Author:

Mahajan Prashant¹,VanBuren John M.²,Tzimenatos Leah³,Cruz Andrea T.⁴,Vitale Melissa⁵,Powell Elizabeth C.⁶,Leetch Aaron N.⁷,Pickett Michelle L.⁸,Brayer Anne⁹,Nigrovic Lise E.¹⁰,Dayan Peter S.¹¹,Atabaki Shireen M.¹²,Ruddy Richard M.¹³,Rogers Alexander J.¹⁴¹⁵,Greenberg Richard²,Alpern Elizabeth R.¹⁶,Tunik Michael G.¹⁷,Saunders Mary⁸,Muenzer Jared¹⁸,Levine Deborah A.¹⁷¹⁹,Hoyle John D.²⁰,Lillis Kathleen Grisanti²¹,Gattu Rajender²²,Crain Ellen F.²³,Borgialli Dominic¹⁵²⁴,Bonsu Bema²⁵,Blumberg Stephen²³,Anders Jennifer²⁶,Roosevelt Genie²⁷,Browne Lorin R.⁸,Cohen Daniel M.²⁸,Linakis James G.²⁹,Jaffe David M.¹⁸,Bennett Jonathan E.³⁰,Schnadower David¹⁸,Park Grace³¹,Mistry Rakesh D.²⁷,Glissmeyer Eric W.²,Cator Allison¹⁴¹⁵,Bogie Amanda³²,Quayle Kimberly S.¹⁸,Ellison Angela¹⁶,Balamuth Fran¹⁶,Richards Rachel²,Ramilo Octavio³³,Kuppermann Nathan³³⁴,

Affiliation:

1. aDivision of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan

2. bDepartment of Pediatrics, Primary Children’s Medical Center, University of Utah, Salt Lake City, Utah

3. cDepartments of Emergency Medicine

4. dSections of Emergency Medicine and Infectious Diseases, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

5. eDivision of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

6. fDivision of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois

7. gDepartments of Emergency Medicine and Pediatrics, University of Arizona College of Medicine, Tucson, Arizona

8. hSection of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin

9. iDepartments of Emergency Medicine and Pediatrics, University of Rochester Medical Center, Rochester, New York

10. jDivision of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, Massachusetts

11. kDivision of Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York City, New York

12. lDivision of Emergency Medicine, Department of Pediatrics, Children’s National Medical Center, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia

13. mDivision of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

14. nDepartments of Pediatrics

15. oDepartment of Emergency Medicine, University of Michigan, Ann Arbor, Michigan

16. pDivision of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

17. qDepartment of Pediatrics

18. rDepartment of Pediatrics, St. Louis Children’s Hospital, Washington University, St. Louis, Missouri

19. sDepartment of Emergency Medicine, Bellevue Hospital, New York University Langone Medical Center, New York City, New York

20. tDepartment of Emergency Medicine, Helen DeVos Children’s Hospital of Spectrum Health, Grand Rapids, Michigan

21. uDepartment of Pediatrics, Women and Children’s Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New York

22. vDivision of Emergency Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, Maryland

23. wDepartment of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, New York City, New York

24. xDepartment of Emergency Medicine, Hurley Medical Center, Flint, Michigan

25. ySection of Emergency Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio

26. zDepartment of Pediatrics, Johns Hopkins University, Baltimore, Maryland

27. aaDepartment of Pediatrics, The Colorado Children’s Hospital, University of Colorado-Denver, Denver, Colorado

28. bbSection of Emergency Medicine, Department of Pediatrics

29. ccDepartments of Emergency Medicine and Pediatrics, Brown University and Hasbro Children’s Hospital, Providence, Rhode Island

30. ddDivision of Pediatric Emergency Medicine, Alfred I. duPont Hospital for Children, Nemours Children's Health System, Wilmington, Delaware

31. eeDepartment of Emergency Medicine, Pediatric Emergency Medicine, The University of New Mexico, Albuquerque, New Mexico

32. ffDivision of Emergency Medicine, Department of Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma

33. ggDivision of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio

34. hhPediatrics, University of California Davis School of Medicine, Sacramento, California

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Link

https://publications.aap.org/pediatrics/article-pdf/doi/10.1542/peds.2021-055633/1374123/peds_2021055633.pdf

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