Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-27T21:32:59.678Z Has data issue: false hasContentIssue false
  • English
  • Français

What is the risk of bacterial meningitis in infants who present to the emergency department with fever and pyuria?

Published online by Cambridge University Press:  21 May 2015

Ran D. Goldman ,
Anne Matlow ,
Lauren Linett  and
Dennis Scolnik
Ran D. Goldman*
Affiliation:
Division of Pediatric Emergency Medicine and Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
Anne Matlow
Affiliation:
Infection, Immunity, Injury and Repair Programme, Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
Lauren Linett
Affiliation:
Division of Pediatric Emergency Medicine and Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
Dennis Scolnik
Affiliation:
Division of Pediatric Emergency Medicine and Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
*
Division of Pediatric Emergency Medicine, Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; 416 813-4915, fax 416 813-5043, [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To determine the rate of bacterial meningitis among febrile infants in the emergency department (ED) who have pyuria detected in an initial catheterized urine specimen.

Methods:

This retrospective chart review, conducted at the Hospital for Sick Children, Toronto, Ont., involved all children aged 0 to 3 months who presented to the ED with fever and pyuria (≥10 white blood cells/mm3) over a 3-year period. Cerebrospinal fluid (CSF) was evaluated using standard methods, and the rate of meningitis in children with pyuria was determined.

Results:

The study sample included 211 infants with fever and pyuria — 79 of these under 1 month of age. Eighty-one percent (171/211) had positive urine cultures, and 143 underwent lumbar puncture to rule out meningitis. Of these, 140 CSF samples were culture negative and 3 grew coagulase negative Staphylococcus — 2 because of contamination and 1 because of a ventriculo-peritoneal shunt infection. Both children with CSF contamination grew Escherichia coli in the urine. The rate of bacterial meningitis in the study sample was 0% (95% confidence interval, 0%–2.6%).

Conclusions:

In this study of febrile children under 90 days of age with fever and pyuria, the incidence of concurrent meningitis was 0%. This suggests that recommendations for mandatory lumbar puncture in such children should be reconsidered. However, until larger prospective studies define a patient subset that does not require CSF analysis, it is prudent to rule out meningitis, administer parenteral antibiotics for urinary tract infection, and admit for close observation.

Keywords

meningitispyuriaurinary tract infectionchildrenemergencies
Type
Pediatric EM • Pédiatrie d’urgence
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 6 , November 2003 , pp. 394 - 399
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Wubbel, L, McCracken, GH Jr. Management of bacterial meningitis: 1998. Pediatr Rev 1998;19:78–84.Google Scholar
2.Baker, MD.Evaluation and management of infants with fever. Pediatr Clin North Am 1999;46:1061–72.Google Scholar
3.Bergstrom, T, Larson, H, Lincoln, K, Winberg, J.Studies of urinary tract infections in infancy and childhood. XII. Eighty consecutive patients with neonatal infection. J Pediatr 1972;80:858–66.Google Scholar
4.Ginsburg, CM, McCracken, GH Jr. Urinary tract infections in young infants. Pediatr 1982;69:409–12.CrossRefGoogle ScholarPubMed
5.Wiswell, TE, Geschke, DW.Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatr 1989;83:1011–5.CrossRefGoogle ScholarPubMed
6.Hoberman, A, Chao, HP, Keller, DM, Hickey, R, Davis, HW, Ellis, D.Prevalence of urinary tract infection in febrile infants. J Pediatr 1993;123:17–23.Google Scholar
7.Bachur, R, Caputo, GL.Bacteremia and meningitis among infants with urinary tract infections. Pediatr Emerg Care 1995;11: 280–4.CrossRefGoogle ScholarPubMed
8.Lin, DS, Huang, SH, Lin, CC, Tung, YC, Huang, TT, Chiu, NC, et al. Urinary tract infection in febrile infants younger than eight weeks of age. Pediatrics 2000;105(2):e20.CrossRefGoogle ScholarPubMed
9.Dayan, PS, Hanson, E, Bennett, J, Langsam, D, Miller, SZ.Benign clinical course of urinary tract infections in infants less than sixty days of age [abstract]. Pediatr Res 2002;51(4 pt 2):280A.Google Scholar
10.Gorelick, MH, Shaw, KN.Screening tests for urinary tract infection in children: a meta-analysis. Pediatrics 1999;104(5):e54.Google Scholar
11.Bonadio, WA.The cerebrospinal fluid: physiologic aspects and alterations associated with bacterial meningitis. Pediatr Infect Dis J 1992;11:423–31.CrossRefGoogle ScholarPubMed
12.Murray, PR, Baron, EJ, Pfaller, A, Tenover, FC, Yolken, RH.Manual of clinical microbiology. 7th ed. Washington (DC): American Society for Microbiology Press; 1999.Google Scholar
13.Johnson, G, Nelson, S, Petric, M, Tellier, R.Comprehensive PCR-based assay for detection and species identification of human herpes viruses. J Clin Microbiol 2000;38:3274–9.Google Scholar
14.Hoberman, A, Wald, ER.Urinary tract infections in febrile infections. Pediatr Infect Dis J 1997;16:11–7.Google Scholar
15.Hoberman, A, Wald, ER, Reynolds, EA, Penchansky, L, Charron, M.Is urine culture necessary to rule out urinary tract infection in young febrile children? Pediatr Infect Dis J 1996;15:304–9.Google Scholar
16.Hoberman, A, Wald, ER, Reynolds, EA, Penchansky, L, Charron, M.Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever. J Pediatr 1994;124: 513–9.Google Scholar
17.Shaw, KN, McGowan, KL.Rapid screening for urinary tract infection (urinary tract infection) in children: a new filter method does not “check-out” for kids. Pediatr Infect Dis J 1997;16:283–7.Google Scholar
18.Lockhart, GR, Lewander, WJ, Cimini, DM, Josephson, SL, Linakis, JG.Use of urinary gram stain for detection of urinary tract infection in infants. Ann Emerg Med 1995;25:31–5.Google Scholar
19.Shaw, KN, McGowan, KL, Gorelick, MH, Schwartz, JS.Screening for urinary tract infection in infants in the emergency department: Which test is best? Pediatr 1998;101:e1.CrossRefGoogle ScholarPubMed
20.Turner, GM, Coulthard, MG.Fever can cause pyuria in children. BMJ 1995;311:924.Google Scholar