Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
JAMA Netw Open. 2021 May 3;4(5):e214544. doi: 10.1001/jamanetworkopen.2021.4544.
Fever in the first months of life remains one of the most common pediatric problems. Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial.
To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required.
MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included.
Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included.
Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using random-effect models.
The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up.
The parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68).
In this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis results ranged from 0.25% to 0.44% and was not higher than that in infants with negative urinalysis results. These results suggest that for these infants, the decision to use LP should not be guided by urinalysis results alone.
在生命的最初几个月，发热仍然是最常见的儿科问题之一。在该人群中，尿路感染是最常见的严重细菌性感染。所有已发表的指南和质量倡议都建议对阳性尿检结果的发热婴儿进行腰椎穿刺（LP）和脑脊液（CSF）检查，以排除细菌性脑膜炎作为病因。对于 28 天以上且尿检异常的健康婴儿，LP 仍然存在争议。
评估阳性尿检结果的 29 至 60 天龄发热婴儿中细菌性脑膜炎的患病率，以评估 LP 是否需要常规进行。
从 2000 年 1 月 1 日至 2018 年 7 月 25 日，通过有针对性地限制近期研究，在 MEDLINE 和 Embase 上搜索发表的文章。在分析之前（2019 年 10 月 6 日）再次进行搜索，以确保纳入新的研究。
报告了健康、足月、外观良好的发热婴儿（29 至 60 天龄）的研究，可获得患者尿液分析结果和脑膜炎状态的个体数据。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南提取数据，并使用纽卡斯尔-渥太华量表评估偏倚。使用随机效应模型估计汇总患病率和比值比（OR）。
主要结局是阳性尿检结果的婴儿中培养证实的细菌性脑膜炎的患病率。次要结局是细菌性脑膜炎的患病率，定义为通过 CSF 检测或临床随访时提示性病史。
主要搜索产生了 3227 条记录；纳入了 48 项研究（25374 名婴儿的 17 个独立数据集）。在 2703 名阳性尿检结果的婴儿中，培养证实的脑膜炎患病率为 0.44%（95%CI，0.25%-0.78%），而在 10032 名阴性尿检结果的婴儿中为 0.50%（95%CI，0.33%-0.76%）（OR，0.74；95%CI，0.39-1.38）。在脑膜炎状态通过 CSF 检测或临床随访确定的 4737 名婴儿中，细菌性脑膜炎的患病率为 0.25%（95%CI，0.14%-0.45%），在 20637 名阳性和阴性尿检结果的婴儿中为 0.28%（95%CI，0.21%-0.36%）（OR，0.89；95%CI，0.48-1.68）。
在这项系统评价和荟萃分析中，外观良好的发热 29 至 60 天龄阳性尿检结果的婴儿中细菌性脑膜炎的患病率为 0.25%至 0.44%，并不高于尿检结果阴性的婴儿。这些结果表明，对于这些婴儿，不应仅根据尿检结果决定是否使用 LP。
