Paquette Katryn, Cheng Matthew P, McGillivray David, Lam Christina, Quach Caroline
Infectious Diseases Division, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Center, McGill University, Montréal, Québec, Canada.
Pediatr Emerg Care. 2011 Nov;27(11):1057-61. doi: 10.1097/PEC.0b013e318235ea18.
Guidelines for the management of febrile infants aged 30 to 90 days presenting to the emergency department (ED) suggest that a lumbar puncture (LP) should be performed routinely if a positive urinalysis is found during initial investigations. The aim of our study was to assess the necessity of routine LPs in infants aged 30 to 90 days presenting to the ED for a fever without source but are found to have a positive urine analysis.
We retrospectively reviewed the records of all infants aged 30 to 90 days, presenting to the Montreal Children's Hospital ED from October 2001 to August 2005 who underwent an LP for bacterial culture, in addition to urinalysis and blood and urine cultures. Descriptive statistics and their corresponding confidence intervals were used.
Overall, 392 infants were identified using the microbiology laboratory database. Fifty-seven patients had an abnormal urinalysis. Of these, 1 infant (71 days old) had an Escherichia coli urinary tract infection, bacteremia, and meningitis. This patient, however, was not well on history, and the peripheral white blood cell count was low at 2.9 × 10⁹/L. Thus, the negative predictive value of an abnormal urinalysis for meningitis was 98.2%.
Routine LPs are not required in infants (30-90 days) presenting to the ED with a fever and a positive urinalysis if they are considered at low risk for serious bacterial infection based on clinical and laboratory criteria. However, we recommend that judicious clinical judgment be used; in doubt, an LP should be performed before empiric antibiotic therapy is begun.
针对前往急诊科（ED）就诊的30至90日龄发热婴儿的管理指南建议，如果在初始检查中发现尿常规阳性，应常规进行腰椎穿刺（LP）。我们研究的目的是评估对于前往ED就诊、发热但无明确病因且尿常规呈阳性的30至90日龄婴儿，常规进行LP的必要性。
我们回顾性分析了2001年10月至2005年8月期间前往蒙特利尔儿童医院ED就诊、除进行尿常规、血培养和尿培养外还接受了用于细菌培养的LP的所有30至90日龄婴儿的记录。使用了描述性统计及其相应的置信区间。
总体而言，通过微生物实验室数据库识别出392例婴儿。57例患者尿常规异常。其中，1例婴儿（71日龄）患有大肠杆菌尿路感染、菌血症和脑膜炎。然而，该患者病史不佳，外周血白细胞计数低，为2.9×10⁹/L。因此，尿常规异常对脑膜炎的阴性预测值为98.2%。
对于前往ED就诊、发热且尿常规阳性的（30 - 90日龄）婴儿，如果根据临床和实验室标准被认为发生严重细菌感染的风险较低，则无需常规进行LP。然而，我们建议应进行审慎的临床判断；如有疑问，应在开始经验性抗生素治疗前进行LP。
