Written by Clay Smith
The prevalence of concomitant bacterial meningitis in infants 29-60 days old with UTI was 0.25%. With this low prevalence, some would argue for selective rather than routine LP in such children.
Why does this matter?
It’s unclear whether a LP needs to be performed on infants 29-60 days old found to have a UTI. What is the risk the UTI will also cause bacterial meningitis?
LP with UTI?
This was a meta-analysis of 3 prospective and 17 retrospective studies that determined the overall prevalence of bacterial meningitis in infants 29-60 days old with UTI was 0.25% (95%CI, 0.09%-0.70%). One study had 1,609 patients and made up 41.5% of the total patients in the meta-analysis. Prevalence in that study alone was 0.12% (2/1609). Of the three prospective studies, in which LP was performed on all patients, zero of a combined 72 infants had bacterial meningitis. Not all infants got a LP in the other, retrospective studies, which may have led to selection bias. However, one would think that more ill-appearing infants would be most likely to have LP performed, inflating the prevalence estimate. Regardless, the number is very low, leading to 1000 LPs to detect 2-3 cases with bacterial meningitis. Then again, it is not zero, and the finding of bacterial meningitis would certainly change duration, route (IV vs PO), and intensity of treatment. It seems a frank discussion of the actual risk with families would be in order as we discuss the risk/benefit of performing LP in these cases.
Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis. J Pediatr. 2019 Jun 20. pii: S0022-3476(19)30536-0. doi: 10.1016/j.jpeds.2019.04.053. [Epub ahead of print]
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Reviewed by Thomas Davis