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What is the risk of bacterial meningitis in infants who present to the emergency department with fever and pyuria?

Published online by Cambridge University Press:  21 May 2015

Ran D. Goldman ,
Anne Matlow ,
Lauren Linett  and
Dennis Scolnik
Ran D. Goldman*
Affiliation:
Division of Pediatric Emergency Medicine and Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
Anne Matlow
Affiliation:
Infection, Immunity, Injury and Repair Programme, Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
Lauren Linett
Affiliation:
Division of Pediatric Emergency Medicine and Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
Dennis Scolnik
Affiliation:
Division of Pediatric Emergency Medicine and Department of Pediatrics, Hospital for Sick Children, Toronto, Ont. Department of Pediatrics, University of Toronto, Toronto, Ont.
*
Division of Pediatric Emergency Medicine, Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; 416 813-4915, fax 416 813-5043, ran.goldman@sickkids.ca

Abstract

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Objectives:

To determine the rate of bacterial meningitis among febrile infants in the emergency department (ED) who have pyuria detected in an initial catheterized urine specimen.

Methods:

This retrospective chart review, conducted at the Hospital for Sick Children, Toronto, Ont., involved all children aged 0 to 3 months who presented to the ED with fever and pyuria (≥10 white blood cells/mm3) over a 3-year period. Cerebrospinal fluid (CSF) was evaluated using standard methods, and the rate of meningitis in children with pyuria was determined.

Results:

The study sample included 211 infants with fever and pyuria — 79 of these under 1 month of age. Eighty-one percent (171/211) had positive urine cultures, and 143 underwent lumbar puncture to rule out meningitis. Of these, 140 CSF samples were culture negative and 3 grew coagulase negative Staphylococcus — 2 because of contamination and 1 because of a ventriculo-peritoneal shunt infection. Both children with CSF contamination grew Escherichia coli in the urine. The rate of bacterial meningitis in the study sample was 0% (95% confidence interval, 0%–2.6%).

Conclusions:

In this study of febrile children under 90 days of age with fever and pyuria, the incidence of concurrent meningitis was 0%. This suggests that recommendations for mandatory lumbar puncture in such children should be reconsidered. However, until larger prospective studies define a patient subset that does not require CSF analysis, it is prudent to rule out meningitis, administer parenteral antibiotics for urinary tract infection, and admit for close observation.

Keywords

meningitispyuriaurinary tract infectionchildrenemergencies
Type
Pediatric EM • Pédiatrie d’urgence
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 6 , November 2003 , pp. 394 - 399
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

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