Testing for meningitis in febrile well-appearing young infants with a positive urinalysis

Marie E. Wang, Eric A. Biondi, Russell J. McCulloh, Matthew D. Garber, Beth C. Natt, Brian P. Lucas, Alan R. Schroeder

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: To determine factors associated with cerebrospinal fluid (CSF) testing in febrile young infants with a positive urinalysis and assess the probability of delayed diagnosis of bacterial meningitis in infants treated for urinary tract infection (UTI) without CSF testing. METHODS: We performed a retrospective cohort study using data from the Reducing Excessive Variability in Infant Sepsis Evaluation quality improvement project. A total of 20 570 well-appearing febrile infants 7 to 60 days old presenting to 124 hospitals from 2015 to 2017 were included. A mixed-effects logistic regression was conducted to determine factors associated with CSF testing. Delayed meningitis was defined as a new diagnosis of bacterial meningitis within 7 days of discharge. RESULTS: Overall, 3572 infants had a positive urinalysis; 2511 (70.3%) underwent CSF testing. There was wide variation by site, with CSF testing rates ranging from 64% to 100% for infants 7 to 30 days old and 10% to 100% for infants 31 to 60 days old. Factors associated with CSF testing included: age 7 to 30 days (adjusted odds ratio [aOR]: 4.6; 95% confidence interval [CI]: 3.8-5.5), abnormal inflammatory markers (aOR: 2.2; 95% CI: 1.8-2.5), and site volume .300 febrile infants per year (aOR: 1.8; 95% CI: 1.2-2.6). Among 505 infants treated for UTI without CSF testing, there were 0 (95% CI: 0%-0.6%) cases of delayed meningitis. CONCLUSIONS: There was wide variation in CSF testing in febrile infants with a positive urinalysis. Among infants treated for UTI without CSF testing (mostly 31 to 60-day-old infants), there were no cases of delayed meningitis within 7 days of discharge, suggesting that routine CSF testing of infants 31 to 60 days old with a positive urinalysis may not be necessary.

Original languageEnglish (US)
Article numbere20183979
JournalPediatrics
Volume144
Issue number3
DOIs
StatePublished - Jan 1 2019

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Urinalysis
Meningitis
Fever
Cerebrospinal Fluid
Urinary Tract Infections
Confidence Intervals
Bacterial Meningitides
Odds Ratio
Delayed Diagnosis
Quality Improvement
Sepsis
Cohort Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Wang, M. E., Biondi, E. A., McCulloh, R. J., Garber, M. D., Natt, B. C., Lucas, B. P., & Schroeder, A. R. (2019). Testing for meningitis in febrile well-appearing young infants with a positive urinalysis. Pediatrics, 144(3), [e20183979]. https://doi.org/10.1542/peds.2018-3979

Testing for meningitis in febrile well-appearing young infants with a positive urinalysis. / Wang, Marie E.; Biondi, Eric A.; McCulloh, Russell J.; Garber, Matthew D.; Natt, Beth C.; Lucas, Brian P.; Schroeder, Alan R.

In: Pediatrics, Vol. 144, No. 3, e20183979, 01.01.2019.

Research output: Contribution to journalArticle

Wang, ME, Biondi, EA, McCulloh, RJ, Garber, MD, Natt, BC, Lucas, BP & Schroeder, AR 2019, 'Testing for meningitis in febrile well-appearing young infants with a positive urinalysis', Pediatrics, vol. 144, no. 3, e20183979. https://doi.org/10.1542/peds.2018-3979
Wang, Marie E. ; Biondi, Eric A. ; McCulloh, Russell J. ; Garber, Matthew D. ; Natt, Beth C. ; Lucas, Brian P. ; Schroeder, Alan R. / Testing for meningitis in febrile well-appearing young infants with a positive urinalysis. In: Pediatrics. 2019 ; Vol. 144, No. 3.
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abstract = "BACKGROUND AND OBJECTIVES: To determine factors associated with cerebrospinal fluid (CSF) testing in febrile young infants with a positive urinalysis and assess the probability of delayed diagnosis of bacterial meningitis in infants treated for urinary tract infection (UTI) without CSF testing. METHODS: We performed a retrospective cohort study using data from the Reducing Excessive Variability in Infant Sepsis Evaluation quality improvement project. A total of 20 570 well-appearing febrile infants 7 to 60 days old presenting to 124 hospitals from 2015 to 2017 were included. A mixed-effects logistic regression was conducted to determine factors associated with CSF testing. Delayed meningitis was defined as a new diagnosis of bacterial meningitis within 7 days of discharge. RESULTS: Overall, 3572 infants had a positive urinalysis; 2511 (70.3{\%}) underwent CSF testing. There was wide variation by site, with CSF testing rates ranging from 64{\%} to 100{\%} for infants 7 to 30 days old and 10{\%} to 100{\%} for infants 31 to 60 days old. Factors associated with CSF testing included: age 7 to 30 days (adjusted odds ratio [aOR]: 4.6; 95{\%} confidence interval [CI]: 3.8-5.5), abnormal inflammatory markers (aOR: 2.2; 95{\%} CI: 1.8-2.5), and site volume .300 febrile infants per year (aOR: 1.8; 95{\%} CI: 1.2-2.6). Among 505 infants treated for UTI without CSF testing, there were 0 (95{\%} CI: 0{\%}-0.6{\%}) cases of delayed meningitis. CONCLUSIONS: There was wide variation in CSF testing in febrile infants with a positive urinalysis. Among infants treated for UTI without CSF testing (mostly 31 to 60-day-old infants), there were no cases of delayed meningitis within 7 days of discharge, suggesting that routine CSF testing of infants 31 to 60 days old with a positive urinalysis may not be necessary.",
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AU - Natt, Beth C.

AU - Lucas, Brian P.

AU - Schroeder, Alan R.

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AB - BACKGROUND AND OBJECTIVES: To determine factors associated with cerebrospinal fluid (CSF) testing in febrile young infants with a positive urinalysis and assess the probability of delayed diagnosis of bacterial meningitis in infants treated for urinary tract infection (UTI) without CSF testing. METHODS: We performed a retrospective cohort study using data from the Reducing Excessive Variability in Infant Sepsis Evaluation quality improvement project. A total of 20 570 well-appearing febrile infants 7 to 60 days old presenting to 124 hospitals from 2015 to 2017 were included. A mixed-effects logistic regression was conducted to determine factors associated with CSF testing. Delayed meningitis was defined as a new diagnosis of bacterial meningitis within 7 days of discharge. RESULTS: Overall, 3572 infants had a positive urinalysis; 2511 (70.3%) underwent CSF testing. There was wide variation by site, with CSF testing rates ranging from 64% to 100% for infants 7 to 30 days old and 10% to 100% for infants 31 to 60 days old. Factors associated with CSF testing included: age 7 to 30 days (adjusted odds ratio [aOR]: 4.6; 95% confidence interval [CI]: 3.8-5.5), abnormal inflammatory markers (aOR: 2.2; 95% CI: 1.8-2.5), and site volume .300 febrile infants per year (aOR: 1.8; 95% CI: 1.2-2.6). Among 505 infants treated for UTI without CSF testing, there were 0 (95% CI: 0%-0.6%) cases of delayed meningitis. CONCLUSIONS: There was wide variation in CSF testing in febrile infants with a positive urinalysis. Among infants treated for UTI without CSF testing (mostly 31 to 60-day-old infants), there were no cases of delayed meningitis within 7 days of discharge, suggesting that routine CSF testing of infants 31 to 60 days old with a positive urinalysis may not be necessary.

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