Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah.
Pediatrics. 2022 Oct 1;150(4). doi: 10.1542/peds.2021-055633.
It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis.
To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results.
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.
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.
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.
确定 29 至 60 日龄有阳性尿检结果的发热婴儿中，是否需要常规腰椎穿刺以评估细菌性脑膜炎。
对 2011 年至 2019 年期间在儿科急诊护理应用研究网络急诊科进行的非危急发热婴儿（≤60 日龄）的前瞻性观察性研究进行二次分析。研究对象的体温≥38°C，并进行血培养评估，且有尿检结果可供分析。我们报告阳性尿检结果组和阴性尿检结果组的菌血症和细菌性脑膜炎的患病率。
在 7180 例婴儿中，1090 例（15.2%）有阳性尿检结果。阳性尿检结果组的菌血症风险高于阴性尿检结果组（63/1090[5.8%] vs 69/6090[1.1%]，差异为 4.7%[3.3%至 6.1%]）。≤28 日龄的婴儿中，阳性尿检结果组和阴性尿检结果组的细菌性脑膜炎患病率无差异（两组均约为 1%）。然而，在 697 例年龄为 29 至 60 日龄、有阳性尿检结果的婴儿中，无细菌性脑膜炎病例，而在 4153 例有阴性尿检结果的婴儿中，有 9 例（0.2%，差异-0.2%[-0.4%至-0.1%]）。此外，在 148 例≤60 日龄、有阳性尿检结果且符合儿科急诊护理应用研究网络低危血界值（绝对中性粒细胞计数<4×103 细胞/mm3 和降钙素原<0.5ng/mL）的婴儿中，也没有菌血症和/或细菌性脑膜炎病例。
在≤60 日龄的非危急发热婴儿中，有阳性尿检结果的 29 至 60 日龄婴儿中没有细菌性脑膜炎病例，在任何月龄的低危婴儿中，根据低危血界值，也没有菌血症和/或细菌性脑膜炎病例。这些发现可指导腰椎穿刺的使用和其他临床决策。
