Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results

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.

Citing Articles

Fever without source in infants aged 22-60 days: how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?.

Vachon K, Gravel G, Leduc S, Larouche A, Mallet M, Simonyan D World J Emerg Med. 2025; 16(1):74-77.

PMID: 39906105 PMC: 11788111. DOI: 10.5847/wjem.j.1920-8642.2025.004.

La prise en charge des nourrissons de 90 jours ou moins, fiévreux mais dans un bon état général.

Burstein B, Lirette M, Beck C, Chauvin-Kimoff L, Chan K Paediatr Child Health. 2024; 29(1):50-66.

PMID: 38332975 PMC: 10848124. DOI: 10.1093/pch/pxad084.

Management of well-appearing febrile young infants aged ≤90 days.

Burstein B, Lirette M, Beck C, Chauvin-Kimoff L, Chan K Paediatr Child Health. 2024; 29(1):50-66.

PMID: 38332970 PMC: 10848123. DOI: 10.1093/pch/pxad085.

Conundrums in the Management of Febrile Infants under Three Months of Age and Future Research.

Wilcox H, Umana E, Fauteux-Lamarre E, Velasco R, Waterfield T Antibiotics (Basel). 2024; 13(1).

PMID: 38247647 PMC: 10812496. DOI: 10.3390/antibiotics13010088.

Clinical characteristics and outcomes in febrile infants aged 29-90 days with urinary tract infections and cerebrospinal fluid pleocytosis.

Moon G, Shin D, Kim Y, Choi S Front Pediatr. 2023; 11:1196992.

PMID: 37325358 PMC: 10267820. DOI: 10.3389/fped.2023.1196992.

References

Greenhow T, Hung Y, Herz A . Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics. 2012; 129(3):e590-6. DOI: 10.1542/peds.2011-1546. View

Aronson P, Thurm C, Williams D, Nigrovic L, Alpern E, Tieder J . Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age. J Hosp Med. 2015; 10(6):358-65. PMC: 4456211. DOI: 10.1002/jhm.2329. View

Aronson P, Thurm C, Alpern E, Alessandrini E, Williams D, Shah S . Variation in care of the febrile young infant <90 days in US pediatric emergency departments. Pediatrics. 2014; 134(4):667-77. DOI: 10.1542/peds.2014-1382. View

Velasco R, Benito H, Mozun R, Trujillo J, Merino P, Mintegi S . Febrile young infants with altered urinalysis at low risk for invasive bacterial infection. a Spanish Pediatric Emergency Research Network's Study. Pediatr Infect Dis J. 2014; 34(1):17-21. DOI: 10.1097/INF.0000000000000482. View

DeAngelis C, Joffe A, Wilson M, Willis E . Iatrogenic risks and financial costs of hospitalizing febrile infants. Am J Dis Child. 1983; 137(12):1146-9. DOI: 10.1001/archpedi.1983.02140380006003. View

Tzimenatos L, Mahajan P, Dayan P, Vitale M, Linakis J, Blumberg S . Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics. 2018; 141(2). PMC: 5810602. DOI: 10.1542/peds.2017-3068. View

Young B, Nguyen T, Alabaster A, Greenhow T . The Prevalence of Bacterial Meningitis in Febrile Infants 29-60 Days With Positive Urinalysis. Hosp Pediatr. 2018; 8(8):450-457. DOI: 10.1542/hpeds.2017-0254. View

Thomson J, Cruz A, Nigrovic L, Freedman S, Garro A, Ishimine P . Concomitant Bacterial Meningitis in Infants With Urinary Tract Infection. Pediatr Infect Dis J. 2017; 36(9):908-910. DOI: 10.1097/INF.0000000000001626. View

Kuppermann N, Dayan P, Levine D, Vitale M, Tzimenatos L, Tunik M . A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019; 173(4):342-351. PMC: 6450281. DOI: 10.1001/jamapediatrics.2018.5501. View

10.

Nigrovic L, Mahajan P, Blumberg S, Browne L, Linakis J, Ruddy R . The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants. Pediatrics. 2017; 140(1). PMC: 5495524. DOI: 10.1542/peds.2017-0695. View

11.

Lyons T, Cruz A, Freedman S, Neuman M, Balamuth F, Mistry R . Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture. Ann Emerg Med. 2017; 69(5):622-631. PMC: 5406248. DOI: 10.1016/j.annemergmed.2016.10.008. View

12.

Pingree E, Kimia A, Nigrovic L . The effect of traumatic lumbar puncture on hospitalization rate for febrile infants 28 to 60 days of age. Acad Emerg Med. 2015; 22(2):240-3. DOI: 10.1111/acem.12582. View

13.

Yankova L, Neuman M, Wang M, Woll C, DePorre A, Desai S . Febrile Infants ≤60 Days Old With Positive Urinalysis Results and Invasive Bacterial Infections. Hosp Pediatr. 2020; 10(12):1120-1125. PMC: 7684554. DOI: 10.1542/hpeds.2020-000638. View

14.

Blaschke A, Holmberg K, Daly J, Leber A, Bard J, Korgenski E . Retrospective Evaluation of Infants Aged 1 to 60 Days with Residual Cerebrospinal Fluid (CSF) Tested Using the FilmArray Meningitis/Encephalitis (ME) Panel. J Clin Microbiol. 2018; 56(7). PMC: 6018345. DOI: 10.1128/JCM.00277-18. View

15.

Wallace S, Brown D, Cruz A . Prevalence of Concomitant Acute Bacterial Meningitis in Neonates with Febrile Urinary Tract Infection: A Retrospective Cross-Sectional Study. J Pediatr. 2017; 184:199-203. DOI: 10.1016/j.jpeds.2017.01.022. View

16.

Mahajan P, Kuppermann N, Mejias A, Suarez N, Chaussabel D, Casper T . Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger. JAMA. 2016; 316(8):846-57. PMC: 5122927. DOI: 10.1001/jama.2016.9207. View

17.

Velasco R, Lejarzegi A, Gomez B, de la Torre M, Duran I, Camara A . Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection. Arch Dis Child. 2020; 106(8):758-763. DOI: 10.1136/archdischild-2020-320468. View

18.

Paxton R, Byington C . An examination of the unintended consequences of the rule-out sepsis evaluation: a parental perspective. Clin Pediatr (Phila). 2001; 40(2):71-7. DOI: 10.1177/000992280104000202. View

19.

Rogers A, Kuppermann N, Anders J, Roosevelt G, Hoyle Jr J, Ruddy R . Practice Variation in the Evaluation and Disposition of Febrile Infants ≤60 Days of Age. J Emerg Med. 2019; 56(6):583-591. PMC: 6589384. DOI: 10.1016/j.jemermed.2019.03.003. View

20.

Pantell R, Roberts K, Adams W, Dreyer B, Kuppermann N, OLeary S . Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021; 148(2). DOI: 10.1542/peds.2021-052228. View