Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis.

@article{Nugent2019RiskOM,
  title={Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis.},
  author={James T. Nugent and Molly Childers and Nicholas Singh-Miller and Robin S. Howard and Rhonda J. Allard and Matthew D. Eberly},
  journal={The Journal of pediatrics},
  year={2019}
}
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16 Citations
Background Citations
2
Results Citations
1

16 Citations

Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results
TLDR
Findings suggest that, contrary to all published guidelines, invasive CSF testing in well-appearing febrile infants in the second month of life based on a positive urinalysis result alone is not supported by differential risk ratios.
Outpatient and oral management is suitable for infants 60–90 days old with urinary tract infections at low risk of bacteremia
TLDR
A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia and outpatient management with appropriate follow-up is safe for these infants.
Infant Escherichia coli urinary tract infection: is it associated with meningitis?
TLDR
Using a retrospective cohort design, the authors determine the prevalence of co-existing bacterial meningitis in infants and young children in the presence of Escherichia coli urinary tract infection and suggest CSF E. coli PCR can help further reduce post-test probability of BM in the setting of pleocytosis.
Febrile Infants ≤60 Days Old With Positive Urinalysis Results and Invasive Bacterial Infections.
TLDR
The sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count is suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI.
Prevalence of Co-Existing E. coli Urinary Tract Infection With Meningitis in Children Under 2 Years: Are We Carrying Out Too Many Lumbar Punctures?
TLDR
Routine lumber punctures could be avoided in well-appearing infants with a diagnosis of E. coli UTI with the greatest impact seen in children up to 6 months of age, as well as in cases with CSF pleocytosis.
CHILDHOOD URINARY TRACT INFECTION: CLINICAL SIGNS, BACTERIAL CAUSES AND ANTIBIOTIC SUSCEPTIBILITY
TLDR
Fever was the most frequent symptom that occurred while other UTI symptoms were less frequent than that reported in adult patients for UTI, and the most common  symptom of UTI are fever and lack of more obvious symptoms ofUTI in adult Patients.
Short-course intravenous antibiotics for young infants with urinary tract infection
TLDR
Short course IV antibiotics for <48 hours for young infants with non-bacteraemic UTI should be considered, provided meningitis has been excluded, and Fever and pyelonephritis were independent predictors of bacteraemia.
Risk-stratification in febrile infants 29 to 60 days old: a cost-effectiveness analysis
TLDR
The Boston clinical prediction rule offers an economically reasonable strategy compared to alternatives for identification of SBI and is likely to be favored at a willingness-to-pay threshold of $100,000/QALY.
Risk of meningitis in infants with urinary tract infection
  • Medicine, Biology
    Journal of paediatrics and child health
  • 2019
TLDR
Although a less common cause of severe bronchiolitis and recurrent wheeze than RSV, rhinovirus C is clearly an important pathogen for infants.
Is a lumbar puncture a necessary investigation in a 2-month-old infant with a probable urinary tract infection?
TLDR
Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months and guidance | NICE.
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References

SHOWING 1-10 OF 58 REFERENCES
The Prevalence of Bacterial Meningitis in Febrile Infants 29-60 Days With Positive Urinalysis.
TLDR
Antibiotic treatment of infants with positive results for urinalysis without lumbar puncture may be safe in selected cases, and the prevalence of bacterial meningitis does not differ byUrinalysis in febrile infants 29 to 60 days old.
[Etiology and clinical course of urinary tract infections in infants less than 3 months-old].
The Age-Related Risk of Co-Existing Meningitis in Children with Urinary Tract Infection
TLDR
Clinicians should have a low threshold to perform a lumbar puncture in neonates with UTI, as the risk of co-existing meningitis is not insignificant in this age group, and beyond the neonatal period, the risk is small and a more selective approach is warranted.
Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis
TLDR
A meta-analysis to determine the pooled prevalence of urinary tract infection in children by age, gender, race, and circumcision status found uncircumcised male infants less than 3 months of age and females less than 12 months ofAge had the highest baseline prevalence of UTI.
Concomitant Bacterial Meningitis in Infants With Urinary Tract Infection
TLDR
Age-stratified prevalence of concomitant bacterial meningitis in infants ⩽60 days with a urinary tract infection is determined and rare, but more common in infants 0–28 days of age.
Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections.
TLDR
Sterile CSF pleocytosis occurs in 18% of young infants with UTIs and patients at very low risk for adverse events may not require longer treatment with antibiotics, according to a multicenter retrospective review.
Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study.
Aseptic meningitis in infants younger than six months of age hospitalized with urinary tract infections
TLDR
A cerebrospinal fluid pleocytosis is relatively common in hospitalized infants <6 months of age who have a UTI and usually does not reflect bacterial meningitis, and knowledge of this may prevent unnecessary courses of antibiotics for presumed bacterial Meningitis and lead to evaluation for other possible causes.
What is the risk of bacterial meningitis in infants who present to the emergency department with fever and pyuria?
TLDR
In this study of febrile children under 90 days of age with fever and pyuria, the incidence of concurrent meningitis was 0%, suggesting that recommendations for mandatory lumbar puncture in such children should be reconsidered.
Factors Associated With Bacteremia in Young Infants With Urinary Tract Infection
TLDR
In infants aged 0–2 months with UTI, increased blood creatinine value at admission was associated with bacteremia, and this value provides an additional clue on admission, independent of personal judgment, to help identify infants at higher risk for bacterenmia, prolonged hospitalization and possible complications.
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