Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results 

Prashant Mahajan, MD, MPH, MBA; John M. VanBuren, PhD; Leah Tzimenatos, MD; Andrea T. Cruz, MD, MPH; Melissa Vitale, MD; Elizabeth C. Powell, MD, MPH; Aaron N. Leetch, MD; Michelle L. Pickett, MD, MS; Anne Brayer, MD; Lise E. Nigrovic, MD, MPH; Peter S. Dayan, MD, MSc; Shireen M. Atabaki, MD, MPH; Richard M. Ruddy, MD; Alexander J. Rogers, MD; Richard Greenberg, MD; Elizabeth R. Alpern, MD, MSCE; Michael G. Tunik, MD; Mary Saunders, MD; Jared Muenzer, MD; Deborah A. Levine, MD; John D. Hoyle, Jr., MD; Kathleen Grisanti Lillis, MD; Rajender Gattu, MD; Ellen F. Crain, MD, PhD; Dominic Borgialli, DO, MPH; Bema Bonsu, MD; Stephen Blumberg, MD; Jennifer Anders, MD; Genie Roosevelt, MD; Lorin R. Browne, DO; Daniel M. Cohen, MD; James G. Linakis, PhD, MD; David M. Jaffe, MD; Jonathan E. Bennett, MD; David Schnadower, MD, MPH; Grace Park, DO, MPH; Rakesh D. Mistry, MD, MS; Eric W. Glissmeyer, MD; Allison Cator, MD, PhD; Amanda Bogie, MD; Kimberly S. Quayle, MD; Angela Ellison, MD, MS; Fran Balamuth, MD, PhD; Rachel Richards, MS; Octavio Ramilo, MD; Nathan Kuppermann, MD, MPH; Pediatric Emergency Care Applied Research Network (PECARN)

Address correspondence to Prashant Mahajan, MD, MPH, MBA, Professor, Emergency Medicine and Pediatrics, Vice-Chair, Department of Emergency Medicine, Section Chief, Children’s Emergency Services, 1540 E. Hospital Drive, CW 2-737, Ann Arbor, MI 48109-4260. E-mail: pmahajan@med.umich.edu

FUNDING: This study was supported in part by grant H34MCO8509 from Health Resources and Services Administration, Emergency Services for Children and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (grants R01HD062477 and R01HD085233). This project was also supported in part by the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children Network Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685. Funded by the National Institutes of Health (NIH).

CONFLICT OF INTEREST DISCLOSURES: Dr Ramilo reports personal fees from Sanofi-Pasteur, Merck, and Pfizer, and grants from Janssen and the Bill & Melinda Gates Foundation. These fees and grants are not related to this study. Dr Hoyle holds the United States patents of 2 drug dosing devices. Currently, there are no licensing arrangements, royalty streams or other financial arrangements. The other authors have indicated they have no potential conflicts of interest relevant to this article to disclose.

Pediatrics e2021055633.

https://doi.org/10.1542/peds.2021-055633

OBJECTIVE:

To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results.

METHODS:

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.

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.

CONCLUSIONS:

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.